Publications by authors named "Francis J Bowden"

50 Publications

Compression Therapy to Prevent Recurrent Cellulitis of the Leg. Reply.

N Engl J Med 2020 11;383(19):1891-1892

University of Canberra, Canberra, ACT, Australia.

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http://dx.doi.org/10.1056/NEJMc2029458DOI Listing
November 2020

Compression Therapy to Prevent Recurrent Cellulitis of the Leg.

N Engl J Med 2020 08;383(7):630-639

From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia.

Background: Chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness.

Methods: In this single-center, randomized, nonblinded trial, we assigned participants with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments.

Results: A total of 183 patients were screened, and 84 were enrolled; 41 participants were assigned to the compression group, and 43 to the control group. At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.59; Pā€‰=ā€‰0.002; relative risk [post hoc analysis], 0.37; 95% CI, 0.16 to 0.84; Pā€‰=ā€‰0.02), and the trial was stopped for efficacy. A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between the two groups. No adverse events occurred during the trial.

Conclusions: In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment. (Funded by Calvary Public Hospital Bruce; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000412336.).
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http://dx.doi.org/10.1056/NEJMoa1917197DOI Listing
August 2020

Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol.

BMJ Open 2019 08 15;9(8):e029225. Epub 2019 Aug 15.

Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.

Introduction: Cellulitis represents a significant burden to patients' quality of life (QOL) and cost to the healthcare system, especially due to its recurrent nature. Chronic oedema is a strong risk factor for both an initial episode of cellulitis and cellulitis recurrence. Expert consensus advises compression therapy to prevent cellulitis recurrence in individuals with chronic oedema, however, there is little supporting evidence. This research aims to determine if the management of chronic oedema using compression therapy effectively delays the recurrence of lower limb cellulitis.

Methods And Analysis: A randomised controlled trial with cross-over will be used to assess the impact of compression therapy on clinical outcomes (time to next episode of cellulitis, rate of cellulitis-related hospital presentations, QOL and leg volume). Using concealed allocation, 162 participants will be randomised into the intervention (compression) or control (no compression) group. Randomisation will be stratified by prophylactic antibiotic use. Participants will be followed up at 6 monthly intervals for up to 3 years or until 45 episodes of cellulitis occur across the cohort. Following an episode of recurrent cellulitis, control group participants will cross-over to the intervention group. Survival analysis will be undertaken to assess the primary outcome measure of time to cellulitis recurrence. The hypotheses are that compression therapy to control lower limb chronic oedema will delay recurrent lower limb cellulitis, reduce the rate of associated hospitalisations, minimise affected limb volume and improve the QOL of this population.

Ethics And Dissemination: Ethics approval has been obtained from the ethics committees of all relevant institutions. Results will be disseminated through relevant peer-reviewed journal articles and conference presentations.

Trial Registration Number: ACTRN12617000412336; Pre-results. The ICTOC trial is currently in progress. Participant recruitment started in May 2017 and is expected to continue until December 2019.
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http://dx.doi.org/10.1136/bmjopen-2019-029225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701661PMC
August 2019

Subconjunctival gentamicin-induced macular toxicity following sutureless 25-gauge vitrectomy.

Clin Exp Ophthalmol 2017 Apr 20;45(3):301-304. Epub 2016 Oct 20.

Australian National University, Acton, Canberra, Australia.

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http://dx.doi.org/10.1111/ceo.12842DOI Listing
April 2017

Can pharmacy assistants play a greater role in public health programs in community pharmacies? Lessons from a chlamydia screening study in Canberra, Australia.

Res Social Adm Pharm 2014 Sep-Oct;10(5):801-6. Epub 2013 Dec 3.

Academic Unit of Internal Medicine, The Australian National University Medical School, Building 4, Level 2, Canberra Hospital, P.O. Box 11, Woden, ACT 2606, Australia; Canberra Sexual Health Centre, Canberra Hospital, P.O. Box 11, Woden, ACT 2606, Australia.

Background: Little is known about the engagement of pharmacy assistants (PA) in public health service provision.

Objective: To explore the experiences of PA participating in a study to determine whether a cash reward, offered to consumers and pharmacy businesses, increased participation in community pharmacy-based chlamydia screening.

Methods: PA experience of the study education and training package, participant recruitment and conducting screening (providing information about chlamydia, specimen collection and handling urine samples) were evaluated using knowledge assessment, a questionnaire and focus groups.

Results: Twenty PA participated in the study: 15 (75%) completed all education and training components, 20 (100%) completed the questionnaire and 10 (50%) attended a focus group. PA rated all education and training components as effective (mean visual analog scale scores >8.5). Most PA (13/18, 72.2%) did not support/were unsure about continuing the program, citing the 25% repeat testing rate (presumed to relate to the cash reward) and privacy/confidentiality issues as reasons. Qualitative analysis suggested that minimizing repeat testing, improved workload management and recognition of, and remuneration for, education and training would make this model more acceptable to PA.

Conclusion: Findings from this study support the assertion that PA can play a significant role in public health initiatives.
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http://dx.doi.org/10.1016/j.sapharm.2013.11.006DOI Listing
June 2015

Topical ivermectin 0.5% lotion for treatment of head lice.

Ann Pharmacother 2013 Sep;47(9):1161-7

University of Canberra, Canberra, Australia.

Objective: To investigate the pharmacology, pharmacokinetics, efficacy, adverse effects, and place in therapy of a single application of topical ivermectin 0.5% lotion for head lice treatment.

Data Sources: Literature was obtained by searching MEDLINE, PubMed, CINAHL, and Scopus (January 1980 to January 2013). Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained.

Study Selection And Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective.

Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1% or pyrethrins, with malathion 0.5% lotion used as a second-line treatment. Significantly more of the 289 head lice-infested participants using topical ivermectin 0.5% lotion were lice-free at day 15 when compared with vehicle control (73.8% vs 17.6%; P < .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9% or benzyl alcohol 5%), topical ivermectin 0.5% lotion is well tolerated (pruritus, the most common adverse event, 0.9%) and requires only a single application.

Conclusions: Topical ivermectin 0.5% lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5% is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States.
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http://dx.doi.org/10.1177/1060028013500645DOI Listing
September 2013

'Catching chlamydia': combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.

Aust J Prim Health 2015 ;21(1):79-83

Academic Unit of Internal Medicine, The Australian National University Medical School, Building 4, Level 2, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia.

In Australia and elsewhere, chlamydia screening rates for those aged between 16 and 30 years continue to be low. Innovative, age-appropriate approaches are necessary to increase chlamydia screening among this target group to prevent short- and long-term consequences of the infection such as pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy and infertility. Studies have demonstrated that offering chlamydia screening in community pharmacies may be a useful adjunct to current screening services. Approximately 90% of Australians visit a pharmacy at least once a year. Chlamydia screening and education in community pharmacies with remuneration may provide another option for opportunistic testing as part of a national chlamydia screening scheme. Compensation is an accepted practice in the field of research and has been demonstrated to improve adherence to health promotion activities. In 2011, a cross-sectional study of community pharmacy-based chlamydia screening offered in conjunction with an A$10 cash incentive to participate was conducted in the Australian Capital Territory. As part of this study young people were asked about their experience of, and views about, pharmacy-based chlamydia screening. The views of consented participants were collected using the one-page questionnaire consisting of 10 closed questions and one open-ended question. Participants completed the questionnaire when they returned their urine sample and before being given the cash incentive. Overall participants were highly satisfied with the pharmacy-based chlamydia screening service. Over 60% of questionnaire respondents felt that the payment did affect their decision to have the chlamydia test, and 23% stated that it made no difference. Young people reported that pharmacy-based screening is acceptable and convenient. Accessibility and the small cash incentive played significant roles in increasing participation.
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http://dx.doi.org/10.1071/PY12135DOI Listing
May 2015

Mycoplasma genitalium incidence, organism load, and treatment failure in a cohort of young Australian women.

Clin Infect Dis 2013 Apr 8;56(8):1094-100. Epub 2013 Jan 8.

Centre for Excellence in Rural Sexual Health, Rural Health Academic Centre, Melbourne Medical School, University of Melbourne, Victoria 3010, Australia.

Background: Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with reproductive tract sequelae in women. This study aimed to estimate MG incidence and treatment failure and provide estimates of organism load in infection.

Methods: 1110 women aged 16-25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months, and 12 months, and MG organism load was measured by quantitative polymerase chain reaction (PCR). MG-positive cases were screened for MG 23S ribosomal RNA (rRNA) gene point mutations shown to confer azithromycin resistance using high-resolution melt following PCR.

Results: MG incidence rate was 1.3 per 100 person-years (n=14; 95% confidence interval [CI], .8-2.3); women reporting 3 or more sex partners in the last 12 months had an increased rate of incident infection (rate ratio [RR], 5.1; 95% CI, 1.3-19.6]). There were 3 cases of MG reinfection (0.8 per 100 person-years [95% CI, .1-.9]. Organism load was higher for prevalent than incident infection (P=.04). There were 3 cases of treatment failure (9.4% [95% CI, 2.0-25.0]); organism load was higher in cases with treatment failure than in successfully treated cases (P<.01). An MG 23S rRNA mutation was detected in 5 cases (3 cases of treatment failure and 2 successfully treated).

Conclusions: Although MG incidence was relatively low, testing should be recommended for women considered to be at increased risk based on sexual history. Our results also suggest that organism load might be important in azithromycin treatment failure.
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http://dx.doi.org/10.1093/cid/cis1210DOI Listing
April 2013

Community pharmacy and cash reward: a winning combination for chlamydia screening?

Sex Transm Infect 2013 May 23;89(3):212-6. Epub 2012 Oct 23.

Academic Unit of Internal Medicine, ANU Medical School, Building 4, Level 2, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia.

Objectives: To date, the uptake of chlamydia screening in community pharmacies has been limited. The objective of this cross-sectional study was to determine if a cash reward, offered to both the provider and the consumer of chlamydia screening, increased the uptake of screening in community pharmacies.

Methods: During 4 weeks in 2011, chlamydia screening and education were offered in four city and two suburban pharmacies to people aged 16-30 years. Those who provided a urine sample for testing, contact details, and completed a brief questionnaire were rewarded with $A10. Positive participants, and their nominated contacts, were offered treatment.

Results: Over a period of 751.5 h, 979 testing kits were requested, and 900 (93%) urine samples returned. Using probabilistic linkage methods, we determined that 671/900 (75%) urine samples were from unique individuals. 0.9 unique samples were obtained/hour of screening, 63% of which were provided by men. 19/671 (2.8%; 95% CI 1.7% to 4.4%) people tested positive, 5.2% (95% CI 2.8% to 8.8%) of women, and 1.4% (1.4 0.5 to 3.1) of men. 11/19 (58%) people were contacted and treated-two for suspected pelvic inflammatory disease.

Conclusions: Providing a cash reward to encourage chlamydia screening in community pharmacies resulted in greater participation rates than previously reported pharmacy-based studies, particularly among men. Easily implemented mechanisms to reduce inappropriate repeat screening, incorrect contact details and effects on pharmacy work flow may enhance the efficiency of this approach.
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http://dx.doi.org/10.1136/sextrans-2011-050357DOI Listing
May 2013

A pragmatic assessment of the relative efficiency of outreach chlamydia screening events conducted in non-clinical settings.

BMC Public Health 2012 May 9;12:341. Epub 2012 May 9.

Academic Unit of Internal Medicine, Australian National University Medical School, Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia.

Background: Opportunistic screening for chlamydia in non-clinical settings is becoming more common, but little is known about which settings (or events) offer the best return on investment. We measured the relative efficiency of each screening site and event during the conduct of a chlamydia education and screening outreach program which used a cash incentive to encourage participation (SOC2).

Methods: SOC2 staff identified sites and organised events in non-clinical sites where young people were likely to congregate. 16 to 30 years olds were offered chlamydia education and a cash reward of AUD10 if they chose to be screened for chlamydia. Data collected during these activities were used to calculated five measures of efficiency: i) screening yield' (proportion of people providing a sample), ii) proportion of positive tests, iii) 'event screening tempo' (number of screens performed for every hour that screening is offered), iv) 'staff hour screening tempo' (number of screens performed per hour of staff time) and v) 'chlamydia detection tempo' (number of positive tests detected per hour of screening).

Results: 3011 people (71% male) were screened during 18 events at 10 venues. Overall 'screening yield' was 43.8% (range: 20-77%) and 1.7% (95% CI: 1.1-3.0) of tests were positive (by event range 1-3%). Overall, the 'event screening tempo' was 23.7 screens per event hour (range 8.0-79.0), the 'staff hour screening tempo' was 6.5 screens per staff hour and the 'chlamydia detection tempo' was 0.4 positive tests per hour (range: 0-1.75).

Conclusion: Assessing the efficiency of screening sites and programs should be integral to their conduct. We suggest the use of five measures to enable pragmatic assessment of any screening program. We introduce the terms 'event screening tempo', 'staff hour screening tempo' and 'chlamydia detection tempo' to describe three of these simple measures.
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http://dx.doi.org/10.1186/1471-2458-12-341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3420309PMC
May 2012

Acute hepatitis B infection following a community-acquired needlestick injury.

J Infect 2011 Jun 13;62(6):487-9. Epub 2011 Apr 13.

School of General Practice, Rural and Indigenous Health, Australian National University Medical School, Australia.

We report a case of acute Hepatitis B infection occurring 2 months after a community-acquired needlestick injury. The patient had a history of incomplete vaccination and Hepatitis B vaccine booster was delayed. He did not receive immunoglobulin. This is only the second report of Hepatitis B transmission in this setting.
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http://dx.doi.org/10.1016/j.jinf.2011.04.002DOI Listing
June 2011

Maximising retention in a longitudinal study of genital Chlamydia trachomatis among young women in Australia.

BMC Public Health 2011 Mar 9;11:156. Epub 2011 Mar 9.

Centre for Women's Health, Gender and Society, School of Population Health, University of Melbourne, Victoria 3010, Australia.

Background: Cohort studies are an important study design however they are difficult to implement, often suffer from poor retention, low participation and bias. The aims of this paper are to describe the methods used to recruit and retain young women in a longitudinal study and to explore factors associated with loss to follow up.

Methods: The Chlamydia Incidence and Re-infection Rates Study (CIRIS) was a longitudinal study of Australian women aged 16 to 25 years recruited from primary health care clinics. They were followed up via the post at three-monthly intervals and required to return questionnaires and self collected vaginal swabs for chlamydia testing. The protocol was designed to maximise retention in the study and included using recruiting staff independent of the clinic staff, recruiting in private, regular communication with study staff, making the follow up as straightforward as possible and providing incentives and small gifts to engender good will.

Results: The study recruited 66% of eligible women. Despite the nature of the study (sexual health) and the mobility of the women (35% moved address at least once), 79% of the women completed the final stage of the study after 12 months. Loss to follow up bias was associated with lower education level [adjusted hazard ratio (AHR): 0.7 (95% Confidence Interval (CI): 0.5, 1.0)], recruitment from a sexual health centre as opposed to a general practice clinic [AHR: 1.6 (95% CI: 1.0, 2.7)] and previously testing positive for chlamydia [AHR: 0.8 (95% CI: 0.5, 1.0)]. No other factors such as age, numbers of sexual partners were associated with loss to follow up.

Conclusions: The methods used were considered effective for recruiting and retaining women in the study. Further research is needed to improve participation from less well-educated women.
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http://dx.doi.org/10.1186/1471-2458-11-156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3061916PMC
March 2011

A pilot study of the use of oral ivermectin to treat head lice in primary school students in Australia.

Pediatr Dermatol 2010 Nov-Dec;27(6):595-9

Australian National University Medical School, Canberra Hospital, WODEN ACT, Australia.

Head lice are a common, costly public health problem worldwide. We aimed to determine the feasibility of an ivermectin intervention program. Consenting students in two schools were screened for head lice. Infested students and siblings at one school were offered a head lice fact sheet and two doses of oral ivermectin, 7 days apart. Parents of infested students in the other school were given the same fact sheet and asked to treat the child and siblings using their preferred topical treatment. Seven hundred two of 754 (93.1%) students enrolled in the two schools were screened; 40 (5.3%; 95% CI 3.7-6.9) had head lice; 31 (9.4%; 95% CI 6.1-12.2) in the intervention school and nine (2.5%; 95% CI 1.1-3.8) in the control school. Subsequently 93.6% of children in the intervention school were treated with oral ivermectin. No adverse events were reported. At 6 months the reduction in the head lice infestation rates for the intervention and control schools were 87% and 56%, respectively. This pilot study suggests that school wide screening for head lice and the administration of oral ivermectin is feasible and acceptable. A randomized controlled trial at 20 schools is planned.
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http://dx.doi.org/10.1111/j.1525-1470.2010.01317.xDOI Listing
July 2011

Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners.

BMC Infect Dis 2010 Sep 20;10:274. Epub 2010 Sep 20.

Department of General Practice, The University of Melbourne, 200 Berkley Street, Carlton, Victoria, Australia.

Background: Genital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.

Methods: In-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed.

Results: Perceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT--many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people.

Conclusions: GPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.
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http://dx.doi.org/10.1186/1471-2334-10-274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2949762PMC
September 2010

Experiences and outcomes of partner notification among men and women recently diagnosed with Chlamydia and their views on innovative resources aimed at improving notification rates.

Sex Transm Dis 2010 Apr;37(4):253-8

Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Victoria, Australia.

Objective: To describe the partner notification experiences of individuals diagnosed with chlamydia and to determine what supports might best assist them.

Goal: To determine what supports might best assist chlamydia infected individuals to notify their partners.

Study Design: A telephone survey was undertaken with men and women recently diagnosed with chlamydia across 3 Australian jurisdictions between August 2007 and January 2008.

Results: Of the 286 individuals who agreed to be contacted about the study, 202 (71%) completed the survey. Twenty-three percent (333/1458) of recent partners were notified: men who had sex with men (MSM) notified 15% (133/880) of their partners, heterosexual men 31% (114/370), and women 46% (86/188) of their partners (P < 0.001). Overall, 84% (169/202) of individuals notified at least one partner. The main reasons for informing partners were out of concern for them (44%) or because it was considered "the right thing to do" (37%). The preferred methods for contacting partners were telephone (52%) and face-to-face (30%). E-mail (8%) and short message service (SMS) (11%) were less commonly used; however, if offered a website with anonymous e-mail and SMS services, nearly half of individuals indicated they would find this useful. Of those who had not informed all partners with known contact details (n = 94), 34% reported that if web-based tools were available they would have contacted more partners. Over half of participants would like to have been given antibiotics to give to their partner.

Conclusion: The availability of tailored resources may assist in improving partner notification for chlamydia.
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http://dx.doi.org/10.1097/OLQ.0b013e3181d012e0DOI Listing
April 2010

'Show me the money': financial incentives increase chlamydia screening rates among tertiary students: a pilot study.

Sex Health 2010 Mar;7(1):60-5

Academic Unit of Internal Medicine, Australian National University Medical School, Canberra Clinical School, Canberra Hospital, Woden, ACT, Australia.

Background: We hypothesise that text-messaging and financial incentives would increase tertiary student participation in chlamydia screening.

Methods: A cross-sectional study was conducted over two phases on eight tertiary campuses during 2007. During Phase 1 (6 months) study activities were advertised through student organisations and media. Education and screening were offered during a range of student activities. During Phase 2 (4 days) education and screening were offered via text messages. Non-financial incentives were offered during Phase 1 and a $10 cash incentive was offered during Phase 2. Rates of specimens provided by students and the direct costs incurred during each phase were compared.

Results: 2786 students attended the 31 activities conducted in Phase 1. Of these, 627 students (22.5%) provided urine specimens for chlamydia testing. During Phase 2, the dissemination of 866 text messages resulted in urine specimens from 392 students (45.3%). Costs per test were AUD $175.11 in Phase 1 and AUD $27.13 in Phase 2.

Conclusions: Compared with more labour intensive (and therefore more expensive) screening activities conducted over a 6-month period, offering a small financial incentive to tertiary students through text messaging over a 4-day period significantly increased participation in on-campus chlamydia screening. This model could readily be applied to other populations to increase participation in chlamydia screening.
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http://dx.doi.org/10.1071/SH08091DOI Listing
March 2010

Prevalence of other sexually transmissible infections in patients with newly diagnosed anogenital warts in a sexual health clinic.

Sex Health 2010 Mar;7(1):55-9

Canberra Sexual Health Centre, The Canberra Hospital, Garran, ACT, Australia.

Background: Anogenital warts are a common initial presentation to the Canberra Sexual Health Centre. It is anticipated that the introduction of human papillomavirus vaccination will reduce the incidence of anogenital warts. The present study determines the prevalence of other sexually transmissible infections in patients newly diagnosed with warts who may not have presented for screening without the impetus of a genital lump.

Methods: The prevalence of other sexually transmissible infections in new patients presenting to the Canberra Sexual Health Centre diagnosed with anogenital warts was determined from a retrospective clinical audit from 2002 to 2007.

Results: A total of 1015 new patients were diagnosed with anogenital warts. Of this total cohort, 53 (5.2%) were found to be co-infected with either chlamydia and/or gonorrhoea. Only 13.2% of co-infected patients reported symptoms other than genital lumps. Of co-infected patients 11.3% reported contact with a partner with chlamydia and/or gonorrhoea. Not all patients were screened for other sexually transmissible infections: 762 (75.1%) were screened for chlamydia and 576 (56.7%) were screened for gonorrhoea. Of those tested, 6.8% of men and 6.9% of women were positive for chlamydia highlighting the importance of offering full sexually transmissible infection screening in those newly diagnosed with anogenital warts. Chlamydia was more common in younger patients who reported a higher number of sexual partners.

Conclusions: It is anticipated that human papillomavirus vaccination will lead to a decline in anogenital wart incidence as well as other human papillomavirus associated disease. Although one opportunity for testing for other sexually transmissible infections may be lost in this population, the decrease in anogenital warts will leave clinicians with more time to pursue other screening programs. Education and screening campaigns should continue to focus on the asymptomatic nature of the majority of sexually transmissible infections.
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http://dx.doi.org/10.1071/SH09023DOI Listing
March 2010

When two tribes go to war.

Authors:
Francis J Bowden

Med J Aust 2009 Dec 7-21;191(11-12):690-1

Academic Unit of Internal Medicine, Australian National University, Canberra, ACT, Australia.

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http://dx.doi.org/10.5694/j.1326-5377.2009.tb03383.xDOI Listing
March 2010

Innovative resources could help improve partner notification for chlamydia in primary care.

Sex Transm Dis 2009 Dec;36(12):779-83

Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia.

Objective: To examine practices of general practitioners' (GPs) in relation to partner notification for chlamydia and identify the supports they would find most useful to assist them.

Goal: To identify innovative resources that could improve partner notification for chlamydia in primary care.

Study Design: A postal survey was undertaken that involved GPs from several jurisdictions across Australia between August and December 2007. GPs were randomly selected from a national database.

Results: Of 521 eligible GPs, 234 (45%) returned a completed questionnaire. Ninety-five percent (n = 223) felt that it was their role to discuss partner notification with patients diagnosed with chlamydia; however, only 45% (105/232) were sure how best to assist their patients with this. Considerable variation was shown in the way partner notification was undertaken, including how far back in time GPs recommended contacting partners. GPs considered a wide range of possible resources useful, including a website supporting patients (90%), information sheets generated by practice software when chlamydia is diagnosed (90%), printed information packs for patients (85%), a website designed to assist GPs (80%), and referral to these websites via positive laboratory results (85%). Forty-three percent currently undertook patient delivered partner therapy for chlamydia.

Conclusion: GPs want and need greater guidance and resources to assist them with partner notification for chlamydia. Resources utilizing the internet and practice software and mechanisms where GPs are automatically directed to these when chlamydia is diagnosed have wide appeal and the potential to improve the effectiveness of partner notification for chlamydia.
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http://dx.doi.org/10.1097/OLQ.0b013e3181b357f6DOI Listing
December 2009

The case for resurrecting the long case.

BMJ 2008 May;336(7655):1250

Australian National University Medical School at The Canberra Hospital, Canberra.

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http://dx.doi.org/10.1136/bmj.39583.596111.94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405870PMC
May 2008

Screening for hepatitis C in sexual health clinic attendees.

Sex Health 2008 Mar;5(1):73-6

Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia.

Introduction: Hepatitis C virus (HCV) prevalence has been shown to be higher in some sexual health clinic attendees than the general population. Screening for HCV in sexual health clinics may be based on risk assessment or universal screening. The aim of this audit was to explore the value of routine HCV screening in a sexual health centre population.

Methods: Medical records and pathology data concerning all patients tested for HCV between 2000 and 2002 at Canberra Sexual Health Centre were audited to determine whether the diagnosis of HCV was already known and which, if any, risk factors were identified at the time of testing.

Results: A total of 3845 tests were conducted on 3156 individuals over the 3-year period. HCV seropositivity was confirmed in 95 patients (3.0%; 95% CI 2.4-3.7), of which 29 (30.5%) were new diagnoses. A total of 85.3% of all patients with confirmed HCV infection reported a history of injecting drug use. Tattoos and body piercings were the most common risk factor in those who denied ever injecting. Risk factor assessment correctly identified all but one positive patient.

Conclusions: HCV testing based on clinician-led risk assessment is an effective approach to HCV screening.
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http://dx.doi.org/10.1071/sh07034DOI Listing
March 2008

Temporal associations with declining Trichomonas vaginalis diagnosis rates among women in the state of Victoria, Australia, 1947 to 2005.

Sex Transm Dis 2008 Jun;35(6):572-6

School of Population Health, University of Melbourne, Victoria, Australia.

Background: To investigate the temporal associations between Trichomonas vaginalis (TV) diagnoses in women at a large urban sexual health clinic and a major Papanicolaou (Pap) smear screening laboratory in Victoria, Australia with Pap smear screening rates and the introduction of nitroimidazole treatments.

Methods: An ecological analysis of TV diagnosis rates at the Melbourne Sexual Health Centre and the Victorian Cytology Service, Pap smear screening rates and nitroimidazole prescription data.

Results: Diagnoses of TV at the Melbourne Sexual Health Centre peaked in the 1950s at 20% to 30% and then rapidly declined through the 1960s and 1970s to below 1% in 1990. A similar pattern was observed at the Victorian Cytology Service. Metronidazole prescribing and opportunistic Pap smear screening began in Victoria in the 1960s coinciding with declining TV. The availability of tinidazole in 1976 led to further declines in TV in the late 1970s. A national cervical screening program introduced in 1991 was temporally associated with further declines in TV.

Conclusions: Our analyses suggest that the introduction of metronidazole was associated with a large reduction in TV among Victorian women in the 1960s. The subsequent availability of tinidazole and increased Pap smear screening may have contributed to the current low TV prevalence in Victoria.
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June 2008

"Let's not talk about sex": reconsidering the public health approach to sexually transmissible infections in remote Indigenous populations in Australia.

Med J Aust 2008 Feb;188(3):182-4

Academic Unit of Internal Medicine, Australian National University Medical School, Canberra, ACT, Australia.

Sexually transmissible infections (STIs) are hyperendemic in some remote Indigenous populations in Australia. Screening programs have had some success in reducing the prevalence of STIs in specific populations, but there has been little overall improvement in the past 10 years. We question the usefulness of current practice and urge consideration of a new and radical approach. Instead of a "screen, treat and contact trace" strategy, we suggest adopting the same approach as currently accepted for trachoma control: populations reaching a threshold prevalence for a set of marker STIs (identified through sentinel surveillance) should be offered a treatment program aimed at the entire sexually active population. We also recommend a parallel program of health promotion and "life skills" education and outline the arguments for such a departure from currently accepted public health policy.
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http://dx.doi.org/10.5694/j.1326-5377.2008.tb01569.xDOI Listing
February 2008

Screening for Chlamydia trachomatis at the time of routine Pap smear in general practice: a cluster randomised controlled trial.

Med J Aust 2008 Jan;188(2):76-80

Academic Unit of Internal Medicine, Australian National University, Canberra, ACT, Australia.

Objective: To determine whether asking general practitioners to offer chlamydia screening at the same time as Pap screening increases chlamydia screening rates.

Design: A pragmatic cluster randomised controlled trial.

Participants And Setting: Doctors from 31 general practices in the Australian Capital Territory performing more than 15 Pap smear screens per year, and all women aged 16-39 years attending those practitioners between 1 November 2004 and 31 October 2005.

Intervention: Doctors in the intervention practices were asked to routinely offer combined chlamydia and Pap screening to eligible women; doctors in the control practices were asked to implement screening guidelines based on a risk assessment of the individual patient (ie, usual practice).

Main Outcome Measure: Chlamydia screening rate per visit.

Results: There were 26 876 visits by eligible women during the study period: 16 082 to intervention practices and 10 794 to control practices. Chlamydia screening occurred during 6.9% (95% CI, 6.5%-7.3%) of visits to intervention practices and 4.5% (95% CI, 4.1%-4.9%) of visits to control practices. After controlling for clustering and potential confounders, there were twofold greater odds of chlamydia screening occurring during a visit by an eligible woman to an intervention practice than to a control practice (adjusted odds ratio, 2.1 [95% CI, 1.3-3.4]).

Conclusion: Combining chlamydia and Pap screening increases the rate of chlamydia screening in general practice. Implementing this approach would require little additional infrastructure support in settings where a cervical screening program already exists.
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http://dx.doi.org/10.5694/j.1326-5377.2008.tb01526.xDOI Listing
January 2008

Community-based sexual health care works: a review of the ACT outreach program.

Sex Health 2007 Sep;4(3):201-4

Masters of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, ANU College of Medicine and Health Science, The Australian National University, Canberra, ACT 2600, Australia.

Background: Men who have sex with men, sex workers, youth and university students are at increased risk for sexually transmissible infections (STI) and blood-borne viruses (BBV) and are therefore targets for sexual health services. In recognition of this, a collaborative project offering sexual health care in various outreach settings frequented by these groups was developed.

Methods: Data collected by clinicians during consultations in five outreach venues (a sex-on-premises venue, a community AIDS organisation, a university campus, brothels and a youth centre) between 2002 and 2005 were analysed.

Results: During 119 clinics (~547 clinician hours), 313 individuals (205 males and 108 females) received education and/or testing. Of those screened, 6.0% (15/249) were positive for chlamydia and 12.7% (9/71) tested positive for hepatitis C (HCV) antibodies. No new cases of hepatitis B (HBV) or HIV were identified and 37.2% (71/191) of patients reported never having been previously tested for HIV. Seroprevalence of hepatitis A and HBV antibodies were 53.8% (91/169) and 52.1% (135/259), respectively. More than half of all four groups reported inconsistent use of condoms and 8.6% reported intravenous drug use.

Conclusions: Collaborations between agencies to provide outreach services facilitate community-based sexual health education and screening for groups at higher risk of STI and BBV. The database audit showed that through these outreach services cases of chlamydia and HCV that may have remained undetected were identified. The results also highlight the need for continuing hepatitis vaccination, testing, health promotion and education in these populations.
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http://dx.doi.org/10.1071/sh07003DOI Listing
September 2007

A cluster of nocardial brain abscesses.

Surg Neurol 2007 Jul;68(1):43-9; discussion 49

Department of Infectious Diseases, The Canberra Hospital, Australian Capital Territory 2606, Australia.

Background: Nocardia species are aerobic Gram-positive bacteria that are ubiquitous in the environment. Infection usually occurs through inhalation or direct cutaneous inoculation of the organism. It has been reported that infection is more common in warm, dry climates. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It is an illness associated with significant morbidity and mortality.

Case Descriptions: We report 4 cases of nocardial brain abscesses presenting to TCH, Australia, within a 1-year period. All 4 cases occurred in men without any significant underlying immunocompromise. In 3 of the cases, the diagnosis was only established after craniotomy. All cases were given prolonged antimicrobial therapy. After more than 8 months of follow-up, there have been no deaths or treatment failures. There has been only one other case of nocardial brain abscess at TCH over the past 15 years. We review the current literature on cerebral nocardiosis.

Conclusion: Nocardial brain abscesses are uncommonly encountered at our institution. This cluster of 4 cases over a 1-year period has therefore led us to postulate that the severe drought may be aiding in the transmission of the bacteria. The cases also emphasize the propensity of nocardial infections to mimic other conditions, particularly malignancy, which may lead to delays in appropriate surgical treatment and antimicrobial therapy. The diagnosis requires a high clinical index of suspicion, with early tissue and microbiological diagnosis. Prolonged antimicrobial therapy is required to prevent relapse of the infection.
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July 2007
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