Paediatrics (RCH) - Research Publications
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ItemImpact of dual diagnosis on healthcare and criminal justice costs after release from Queensland prisons: a prospective cohort study(CSIRO Publishing, 2022-05-06)Background. People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective. Methods. A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs. Results. Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6–4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6–5.0), compared with no past diagnosis of either mental illness or substance use disorder. Conclusions. People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison.
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ItemSARS-CoV-2 infections and public health responses in schools and early childhood education and care centres in Victoria, Australia: An observational study(Elsevier, 2022-02)Background: The epidemiology of SARS-CoV-2 in children is an important consideration for control measures. To inform the safe re-opening of Victorian schools and early childhood education and care (ECEC) in late 2020, a detailed analysis of local data was undertaken. Methods: Data on all Victorian SARS-CoV-2 confirmed cases, their close contacts, and ECEC/school events from the first case in Victoria to the end of the third school term (25/01/2020 - 18/09/2020) were analysed. We compared temporal and geographic trends in cases linked to ECEC/school events and community cases; and describe events with onward transmission by age of first case, and public health actions. Findings: Victoria recorded 20,049 SARS-CoV-2 cases during the study period. In total, 1,691 cases and 18,423 contacts were linked to 339 events in ECEC/schools. Many (n=224, 66·1%) events had no evidence of onward transmission, and most (96·5%) involved <10 cases. Onward transmission was more common when the first case was older: when first case was aged 0-5 years, 14·1% events involved additional cases, compared to 30·5% (6-12 years), 33·3% (13-15 years), 42·9% (16-18 years), and 39·1% when the first case was an adult. ECEC/schools were closed within a median of one day (IQR 0-2) from laboratory notification of the first case. Interpretation: Mitigation measures and rapid responses prevented most SARS-CoV-2 cases in ECEC/schools from becoming outbreaks in Victoria in 2020. As new variants emerge and vaccination coverage increases, ECEC/school mitigation strategies should be tailored to local community transmission and educational level. Funding: The Victorian Department of Health and Human Services.
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ItemEmergency health service contact and reincarceration after release from prison: A prospective cohort study(WILEY, 2019-04)BACKGROUND: Adults released from prison often have complex health needs. They are at high risk of poor health outcomes and reincarceration, with health service use unlikely to be planned. AIMS/HYPOTHESES: To determine the incidence of emergency health service (EHS) use, ambulance attendance and/or emergency department presentation, among 1,181 adults released from Australian prisons. We hypothesised that EHS contact would be associated with increased reincarceration risk. METHODS: Baseline surveys were conducted within 6 weeks before release. Postrelease EHS contacts and reincarceration were identified through prospective data linkage. For each participant, EHS contacts within a 24-hour period were combined to make an episode. We used Cox proportional hazards regression to examine the relationship between EHS episodes and reincarceration, controlling for covariates. RESULTS: More than half (53.3%) of participants had at least one EHS contact over a median of 25.6-month follow-up. In adjusted analyses, compared to those with no EHS contacts, the hazard of reincarceration was greater for participants who had one to three EHS episodes (hazard ratio [HR] = 1.84; 95% confidence interval [CI] [1.48, 2.29]) or four or more (HR = 2.35; 95% CI [1.67, 3.29]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Emergency department attendance by people with a history of imprisonment may be indicative of wider decompensation. Improved management of such patients may improve health outcomes and have collateral benefits for reducing reincarceration.
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ItemTuberculosis in adolescents and young adults: epidemiology and treatment outcomes in the Western Cape(INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D), 2017-06)SETTING: Western Cape Province, South Africa. OBJECTIVES: To characterise tuberculosis (TB) epidemiology, disease presentation and treatment outcomes among adolescents (age 10-19 years) and young adults (age 20-24 years) in the Western Cape. DESIGN: A retrospective, cross-sectional review of routine patient-level data from the Electronic TB Register (ETR.Net) for 2013. Site of TB disease, human immunodeficiency virus (HIV) status and TB treatment outcomes were analysed by 5-year age groups (<5, 5-9, 10-14, 15-19, 20-24 and 25 years of age). TB notification rates were calculated using census data. RESULTS: Adolescents and young adults comprised 18.0% of all new TB notifications in 2013. The notification rate was 141 TB cases/100 000 person-years (py) among 10-14 year olds, 418/100 000 py among 15-19 year olds and 627/100 000 py among 20-24 year olds. HIV prevalence among TB patients was 10.9% in 10-14 year olds, 8.8% in 15-19 year olds and 27.2% in 20-24 year olds. Older adolescents (age 15-19 years) and young adults (age 20-24 years) with HIV co-infection had poor treatment outcomes: 15.6% discontinued treatment prematurely and 4.0% died. CONCLUSIONS: Young people in the Western Cape suffer a substantial burden of TB, and those with TB-HIV co-infection are at high risk of treatment discontinuation.
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ItemNo Preview AvailableService brokerage for improving health outcomes in ex-prisoners(Wiley, 2020-09-11)
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ItemCost-utility analysis of low-intensity case management to increase contact with health services among ex-prisoners in Australia(BMJ PUBLISHING GROUP, 2018-08)OBJECTIVES: The economic burden of incarceration is substantial in Australia. People released from prison are at high risk of poor health and this is an important predictor of recidivism. The 'Passports Study' was a randomised controlled trial of an intervention designed to increase health service utilisation after release from prison. The aim of this study is to conduct a cost-utility analysis of this transitional programme. SETTING: Australia DESIGN: A hybrid simulation model was developed to estimate the changes to total economic costs and effectiveness expressed as quality-adjusted life-years (QALYs) from the adoption of the 'Passports' intervention compared with the control group. Model parameters were informed by linked data from Queensland Corrective Services, Medicare, Pharmaceutical Benefits Scheme, Queensland Hospital Admission Patient Data Collection, Emergency Department Information System and National Death Index. Health-related quality of life was measured using the Short-Form 8 Health Survey (SF-8). The primary outcomes were the costs and estimated QALYs associated with the intervention group and the control group. Probabilistic sensitivity analysis was conducted to test parameter uncertainties. RESULTS: Compared with the control group where no attempt was made to encourage health service utilisation, an average participant in the intervention group incurred an extra cost of AUD 1790 and experienced slightly reduced QALYs, which indicated that the intervention was dominated in the baseline analysis. Probabilistic sensitivity analysis revealed that the transitional programme had a low probability of being cost-effective with the outcome measures selected. CONCLUSION: The findings of this study do not provide economic evidence to support the widespread adoption of the Passports intervention. Due to the reductionist nature of the cost-utility approach, it may be that important health-related benefits have been omitted. Another research approach using a wider range of health-related measures might generate different conclusions.
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ItemAge-Specific Global Prevalence of Hepatitis B, Hepatitis C, HIV, and Tuberculosis Among Incarcerated People: A Systematic Review(ELSEVIER SCIENCE INC, 2018-03)PURPOSE: This study aims to compare the global prevalence of hepatitis B, hepatitis C, HIV, and tuberculosis in incarcerated adolescents and young adults (AYAs) and older prisoners. METHODS: This study is a systematic review and meta-analysis of studies reporting the age-specific prevalence of each infection in prisoners. We grouped age-specific prevalence estimates into three overlapping age categories: AYA prisoners (<25 years), older prisoners (≥25 years), and mixed category (spanning age 25 years). We used random effects meta-analysis to estimate the relative risk (RR) of each infection in AYAs versus older prisoners. RESULTS: Among 72 studies, there was marked heterogeneity in prevalence estimates among AYA prisoners for all infections: hepatitis B (.4%-25.2%), hepatitis C (.0%-70.6%), HIV (.0%-15.8%), and active tuberculosis (.0%-3.7%). The pooled prevalence of HIV (RR = .39, 95% confidence interval .29-.53, I2 = 79.2%) and hepatitis C (RR = .51, 95% confidence interval .33-.78, I2 = 97.8%) was lower in AYAs than in older prisoners. CONCLUSIONS: The prevalence of HIV and hepatitis C is lower in AYA prisoners than in older prisoners. Despite lower prevalence, acquisition begins early among incarcerated populations. There is an urgent need for targeted, age-appropriate prevention, treatment, and harm reduction measures in and beyond custodial settings to reduce the incidence of infection in these extremely vulnerable young people.
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ItemPrisons and custodial settings are part of a comprehensive response to COVID-19(ELSEVIER SCI LTD, 2020-04)
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ItemThe health of adolescents in detention: a global scoping review(Elsevier, 2020)Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), selfharm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.
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ItemTuberculosis in pregnant women and neonates: A meta-review of current evidence(Elsevier BV, 2020)Pregnant women and their infants are a vulnerable but neglected population in tuberculosis (TB) control efforts. Recent advances in TB prevention, diagnosis and treatment have implications for their care, despite their frequent exclusion from research. We have conducted a meta-review of current evidence and clinical guidelines for TB prevention, diagnosis and management in pregnant women and neonates, focusing on review articles published since 2010. The actual burden of TB in pregnancy is unmeasured, but has been estimated at 216,500 cases per year. Although the effect of pregnancy on TB risk is uncertain and controversial, two large whole-of-population studies found that pregnancy was associated with a two- to three-fold increase in risk of TB. Congenital TB is rare but extremely serious. Neonates exposed to TB after delivery will be at high risk of disease, and preventive therapy is recommended once disease has been ruled out. At present, there is limited evidence regarding the performance of different screening strategies for pregnant women, appropriate drug dosing for either pregnant women or neonates, and the safety of most second-line drugs in pregnancy. High quality evidence on these topics is needed, as are detailed guidelines to inform efforts by TB control programs and clinicians working with pregnant women and their infants.