The epidemiology of sports and leisure-related injury hospitalisations in Queensland: A five-year review.

OBJECTIVE: To describe the epidemiology of sports and leisure-related injury hospitalisations in Queensland DESIGN, SETTING, AND PATIENTS: Retrospective analysis of routinely collected hospital admissions data from all Queensland hospitals (public and private) between 2012 and 2016 for injury-related admissions where the activity engaged in when injured was coded as sports or leisure activity. MAIN OUTCOME MEASURES: Number of hospitalisations; rate of hospitalisation per 100,000 population and demographic, injury, treatment, and outcome details of hospitalised injury patients. RESULTS: Between 01 January 2012 and 31 December 2016, 76,982 people were hospitalised for a sports or leisure-related injury in Queensland. More people were hospitalised in public hospitals than private. Rates were highest for those under 14 years (601.5/100,000 population) and were higher in males (130.6/100,000 population) than females (28.9/100,000 population). A total of 18,734 injuries (24.3%; 79.5/100,000 population) were sustained while playing team ball sports, with rugby codes (rugby union, rugby league and rugby unspecified) representing the single largest source of injuries with 6,592. The extremities were the most likely body location of injury (46,644; 198/100,000 population), and the most common injury type was a fracture (35,018; 148.6/100,000 population). CONCLUSIONS: The findings highlight the significant burden of sport and leisure-related injury hospitalisations in Queensland. This information is important for injury prevention and trauma system planning.

Understanding compensable and non-compensable patient profiles, pathways and physical outcomes for transport and work-related injuries in Queensland, Australia through data linkage.

INTRODUCTION: In many jurisdictions, people experiencing an injury often pursue compensation to support their treatment and recovery expenses. Healthcare costs form a significant portion of payments made by compensation schemes. Compensation scheme regulators need accurate and comprehensive data on injury severity, treatment pathways and outcomes to enable scheme modelling, monitoring and forecasting. Regulators routinely rely on data provided by insurers which have limited healthcare information. Health data provide richer information and linking health data with compensation data enables the comparison of profiles, patterns, trends and outcomes of injured patients who claim and injured parties who are eligible but do not claim. METHODS AND ANALYSIS: This is a retrospective population-level epidemiological data linkage study of people who have sought ambulatory, emergency or hospital treatment and/or made a compensation claim in Queensland after suffering a transport or work-related injury, over the period 1 January 2011 to 31 December 2021. It will use person-linked data from nine statewide data sources: (1) Queensland Ambulance Service, (2) Emergency Department, (3) Queensland Hospital Admitted Patients, (4) Retrieval Services, (5) Hospital Costs, (6) Workers' Compensation, (7) Compulsory Third Party Compensation, (8) National Injury Insurance Scheme and (9) Queensland Deaths Registry. Descriptive, parametric and non-parametric statistical methods and geospatial analysis techniques will be used to answer the core research questions regarding the patient's health service use profile, costs, treatment pathways and outcomes within 2 years postincident as well as to examine the concordance and accuracy of information across health and compensation databases. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Royal Brisbane and Women's Hospital Human Research Ethics Committee, and governance approval was obtained via the Public Health Act 2005, Queensland. The findings of this study will be used to inform key stakeholders across the clinical, research and compensation regulation area, and results will be disseminated through peer-reviewed journals, conference presentations and reports/seminars with key stakeholders.

Three Es of linked injury data: Episodes, Encounters and Events.

BACKGROUND: Treatment and recovery times following injury can be lengthy, comprising multiple interactions with the hospital system for initial acute care, subsequent rehabilitation and possible re-presentation due to complications. AIMS: This article aims to promote the use of consistent terminology in injury data linkage studies, suggest important factors to consider when managing linked injury data, and encourage thorough documentation and a robust discourse around different approaches to data management to ensure reproducibility, consistency and comparability of analyses arising from linked injury data. APPROACH: This paper is presented in sections describing: (1) considerations for identifying injury cohorts, (2) considerations for grouping Episodes into Encounters and (3) considerations for grouping Encounters into Events. Summary tools are provided to aid researchers in the management of linked injury data. DISCUSSION: Careful consideration of decisions made when identifying injury cohorts and grouping data into units of analysis (Episodes/Encounters/Events) is essential when using linked injury data. Choices made have the potential to significantly impact the epidemiological and clinical findings derived from linked injury data studies, which ultimately affect the quality of injury prevention initiatives and injury management policy and practice. It is intended that this paper will act as a call to action for injury linkage methodologists, and those using linked data, to critique approaches, share tools and engage in a robust discourse to further advance the use of linked injury data, and ultimately enhance the value of linked injury data for clinicians and health and social policymakers.

Culture-independent detection of chlorhexidine resistance genes qacA/B and smr in bacterial DNA recovered from body sites treated with chlorhexidine-containing dressings.

PURPOSE: Dressings containing chlorhexidine gluconate (CHG) are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in staphylococci is primarily associated with the presence of qacA/B and smr genes. METHODOLOGY: We used a culture-independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG dressings. RESULTS: Of the 78 DNA specimens analysed, 52 (67 %) possessed qacA/B and 14 (18 %) possessed smr; all samples positive for smr were also positive for qacA/B. These prevalence rates were not statistically greater than those observed in a subsample of specimens taken from non-CHG treated contralateral arms and non-CHG-dressing exposed arms. A statistically greater proportion of specimens with greater than 72 h exposure to CHG dressings were qac-positive (P=0.04), suggesting that the patients were contaminated with bacteria or DNA containing qacA/B during their hospital stay. The presence of qac genes was not positively associated with the presence of DNA specific for Staphylococcusepidermidis and Staphylococcusaureus in these specimens. CONCLUSION: Our results show that CHG genes are highly prevalent on hospital patients' skin, even in the absence of viable bacteria.

Joint effects of climate variability and socioecological factors on dengue transmission: epidemiological evidence.

OBJECTIVE: To assess the epidemiological evidence on the joint effects of climate variability and socioecological factors on dengue transmission. METHODS: Following PRISMA guidelines, a detailed literature search was conducted in PubMed, Web of Science and Scopus. Peer-reviewed, freely available and full-text articles, considering both climate and socioecological factors in relation to dengue, published in English from January 1993 to October 2015 were included in this review. RESULTS: Twenty studies have met the inclusion criteria and assessed the impact of both climatic and socioecological factors on dengue dynamics. Among those, four studies have further investigated the relative importance of climate variability and socioecological factors on dengue transmission. A few studies also developed predictive models including both climatic and socioecological factors. CONCLUSIONS: Due to insufficient data, methodological issues and contextual variability of the studies, it is hard to draw conclusion on the joint effects of climate variability and socioecological factors on dengue transmission. Future research should take into account socioecological factors in combination with climate variables for a better understanding of the complex nature of dengue transmission as well as for improving the predictive capability of dengue forecasting models, to develop effective and reliable early warning systems.

Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs.

Skin bacteria at peripheral intravenous catheter (PIVC) insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs). Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, p<0.001). Methylobacterium spp. was the dominant genus in all PIVC tip samples, but not so for skin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%), Pseudomonas spp., (10%) and Acinetobacter spp. (10%) were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.

Nature and Extent of Genetic Diversity of Dengue Viruses Determined by 454 Pyrosequencing.

Dengue virus (DENV) populations are characteristically highly diverse. Regular lineage extinction and replacement is an important dynamic DENV feature, and most DENV lineage turnover events are associated with increased incidence of disease. The role of genetic diversity in DENV lineage extinctions is not understood. We investigated the nature and extent of genetic diversity in the envelope (E) gene of DENV serotype 1 representing different lineages histories. A region of the DENV genome spanning the E gene was amplified and sequenced by Roche/454 pyrosequencing. The pyrosequencing results identified distinct sub-populations (haplotypes) for each DENV-1 E gene. A phylogenetic tree was constructed with the consensus DENV-1 E gene nucleotide sequences, and the sequences of each constructed haplotype showed that the haplotypes segregated with the Sanger consensus sequence of the population from which they were drawn. Haplotypes determined through pyrosequencing identified a recombinant DENV genome that could not be identified through Sanger sequencing. Nucleotide level sequence diversities of DENV-1 populations determined from SNP analysis were very low, estimated from 0.009-0.01. There were also no stop codon, frameshift or non-frameshift mutations observed in the E genes of any lineage. No significant correlations between the accumulation of deleterious mutations or increasing genetic diversity and lineage extinction were observed (p>0.5). Although our hypothesis that accumulation of deleterious mutations over time led to the extinction and replacement of DENV lineages was ultimately not supported by the data, our data does highlight the significant technical issues that must be resolved in the way in which population diversity is measured for DENV and other viruses. The results provide an insight into the within-population genetic structure and diversity of DENV-1 populations.

Impacts of El Niño Southern Oscillation and Indian Ocean Dipole on dengue incidence in Bangladesh.

Dengue dynamics are driven by complex interactions between hosts, vectors and viruses that are influenced by environmental and climatic factors. Several studies examined the role of El Niño Southern Oscillation (ENSO) in dengue incidence. However, the role of Indian Ocean Dipole (IOD), a coupled ocean atmosphere phenomenon in the Indian Ocean, which controls the summer monsoon rainfall in the Indian region, remains unexplored. Here, we examined the effects of ENSO and IOD on dengue incidence in Bangladesh. According to the wavelet coherence analysis, there was a very weak association between ENSO, IOD and dengue incidence, but a highly significant coherence between dengue incidence and local climate variables (temperature and rainfall). However, a distributed lag nonlinear model (DLNM) revealed that the association between dengue incidence and ENSO or IOD were comparatively stronger after adjustment for local climate variables, seasonality and trend. The estimated effects were nonlinear for both ENSO and IOD with higher relative risks at higher ENSO and IOD. The weak association between ENSO, IOD and dengue incidence might be driven by the stronger effects of local climate variables such as temperature and rainfall. Further research is required to disentangle these effects.

Dynamic spatiotemporal trends of dengue transmission in the Asia-Pacific region, 1955-2004.

BACKGROUND: Dengue fever (DF) is one of the most important emerging arboviral human diseases. Globally, DF incidence has increased by 30-fold over the last fifty years, and the geographic range of the virus and its vectors has expanded. The disease is now endemic in more than 120 countries in tropical and subtropical parts of the world. This study examines the spatiotemporal trends of DF transmission in the Asia-Pacific region over a 50-year period, and identified the disease's cluster areas. METHODOLOGY AND FINDINGS: The World Health Organization's DengueNet provided the annual number of DF cases in 16 countries in the Asia-Pacific region for the period 1955 to 2004. This fifty-year dataset was divided into five ten-year periods as the basis for the investigation of DF transmission trends. Space-time cluster analyses were conducted using scan statistics to detect the disease clusters. This study shows an increasing trend in the spatiotemporal distribution of DF in the Asia-Pacific region over the study period. Thailand, Vietnam, Laos, Singapore and Malaysia are identified as the most likely clusters (relative risk = 13.02) of DF transmission in this region in the period studied (1995 to 2004). The study also indicates that, for the most part, DF transmission has expanded southwards in the region. CONCLUSIONS: This information will lead to the improvement of DF prevention and control strategies in the Asia-Pacific region by prioritizing control efforts and directing them where they are most needed.

Projecting the impact of climate change on dengue transmission in Dhaka, Bangladesh.

Weather variables, mainly temperature and humidity influence vectors, viruses, human biology, ecology and consequently the intensity and distribution of the vector-borne diseases. There is evidence that warmer temperature due to climate change will influence the dengue transmission. However, long term scenario-based projections are yet to be developed. Here, we assessed the impact of weather variability on dengue transmission in a megacity of Dhaka, Bangladesh and projected the future dengue risk attributable to climate change. Our results show that weather variables particularly temperature and humidity were positively associated with dengue transmission. The effects of weather variables were observed at a lag of four months. We projected that assuming a temperature increase of 3.3°C without any adaptation measure and changes in socio-economic condition, there will be a projected increase of 16,030 dengue cases in Dhaka by the end of this century. This information might be helpful for the public health authorities to prepare for the likely increase of dengue due to climate change. The modelling framework used in this study may be applicable to dengue projection in other cities.

Space-time clusters of dengue fever in Bangladesh.

OBJECTIVE: To examine the space-time clustering of dengue fever (DF) transmission in Bangladesh using geographical information system and spatial scan statistics (SaTScan). METHODS: We obtained data on monthly suspected DF cases and deaths by district in Bangladesh for the period of 2000-2009 from Directorate General of Health Services. Population and district boundary data of each district were collected from national census managed by Bangladesh Bureau of Statistics. To identify the space-time clusters of DF transmission a discrete Poisson model was performed using SaTScan software. RESULTS: Space-time distribution of DF transmission was clustered during three periods 2000-2002, 2003-2005 and 2006-2009. Dhaka was the most likely cluster for DF in all three periods. Several other districts were significant secondary clusters. However, the geographical range of DF transmission appears to have declined in Bangladesh over the last decade. CONCLUSION: There were significant space-time clusters of DF in Bangladesh over the last decade. Our results would prompt future studies to explore how social and ecological factors may affect DF transmission and would also be useful for improving DF control and prevention programs in Bangladesh.

Dengue transmission in the Asia-Pacific region: impact of climate change and socio-environmental factors.

OBJECTIVE: To review the scientific evidence about the impact of climate change and socio-environmental factors on dengue transmission, particularly in the Asia-Pacific region. METHODS: Search of the published literature on PubMed, ISI web of Knowledge and Google Scholar. Articles were included if an association between climate or socio-environmental factors and dengue transmission was assessed in any country of the Asia-Pacific region. RESULTS: Twenty-two studies met the inclusion criteria. The weight of the evidence indicates that global climate change is likely to affect the seasonal and geographical distribution of dengue fever (DF) in the Asia-Pacific region. However, empirical evidence linking DF to climate change is inconsistent across geographical locations and absent in some countries where dengue is endemic. CONCLUSION: Even though climate change may play an increasing role in the transmission of DF, no clear evidence shows that such impact has already occurred. More research is needed across countries to better understand the relationship between climate change and dengue transmission. Future research should also consider and adjust for the influence of important socio-environmental factors in the assessment of the climate change-related effects on dengue transmission.

Forecasting dengue incidence in Dhaka, Bangladesh: A time series analysis.

This article attempts to model the monthly number of dengue fever (DF) cases in Dhaka, Bangladesh,and forecast the dengue incidence using time series analysis. Seasonal Autoregressive Integrated MovingAverage (SARIMA) models have been developed on the monthly data collected from January 2000 toOctober 2007 and validated using the data from September 2006 to October 2007. The results showed that the predicted values were consistent with the upturns and downturns of the observedseries. The SARIMA (1,0,0)(1,1,1)12 model has been found as the most suitable model with least Normalized Bayesian Information Criteria (BIC) of 11.918 and Mean Absolute Percent Error (MAPE) of595.346. The model was further validated by Ljung-Box test (Q18=15.266 and p>.10) with nosignificant auto correlation between residuals at different lag times. Finally, a forecast for the period November 2007 to December 2008 was made, which showed a pick in the incidence of DF during July 2008, with estimated cases as 689.