Dr Tazeen Majeed

Aims This study aims to (1) define the characteristics of patients with a first admission for heart failure (HF), stratified by type (reduced (HFrEF) vs preserved (HFpEF) ejection fraction) in a regional Australian setting; (2) compare the outcomes in terms of mortality and rehospitalisation and (3) assess adherence to the treatment guidelines. Methods We identified all index hospitalisations with HF to John Hunter Hospital and Tamworth Rural Referral Hospital in the Hunter New England Local Health District over a 12 months. We used the recent Australian HF guidelines to classify HFrEF and HFpEF and assess adherence to guideline-directed therapy. The primary outcome of the study was to compare short-term (1 year) and long-term all-cause mortality and the composite of all-cause hospitalisation or all-cause mortality of patients with HFrEF and HFpEF. Results There were 664 patients who had an index HF admission to John Hunter and Tamworth hospitals in 2014. The median age was 80 years, 47% were female and 22 (3%) were Aboriginal. In terms of HF type, 29% had HFrEF, 37% had HFpEF, while the remainder (34%) did not have an echocardiogram within 1 year of admission and could not be classified. The median follow-up was 3.3 years. HFrEF patients were predominantly male (64%) and in 48% the aetiology was ischaemic heart disease. The 1-year all-cause mortality was 23% in HFpEF subgroup and 29% in HFrEF subgroup (p=0.15). Five-year mortality was 61% in HFpEF and HFrEF patients. Of the HFrEF patients, only 61% were on renin-angiotensin-aldosterone blockers, 74% were on ß-blockers and 39% were on aldosterone antagonist. Conclusion HF patients are elderly and about evenly split between HFrEF and HFpEF. In this regional cohort, both HF types are associated with similar 1-year and 5-year mortality following incident HF hospitalisation. Echocardiography and guideline-directed therapies were underused.

Health assessments have potential to improve health of older people. This study compares long-term health care utilisation, physical functioning, and mortality for women aged 75 years or over who have had a health assessment and those who have not. Prospective data on health service use, physical functioning, and deaths among a large cohort of women born 1921¿26 were analysed. Propensity score matching was used to produce comparable groups of women according to whether they had a health assessment or not. The study population included 6128 (67.3%) women who had an assessment, and 2971 (32.7%) women who had no assessment. Propensity matching produced 2101 pairs. Women who had an assessment had more use of other health services, longer survival, and were more likely to survive with high physical functioning compared to women with no assessment. Among women who had good baseline physcial functioning scores, women who had an assessment had significantly lower odds of poor outcomes at 1000 days follow-up compared to women who had no assessment (OR: 0.67, 95%CI: 0.52, 0.85). This large observational study shows the real-world potential for assessments to improve health outcomes for older women. However, they also increased health service use. This increased healthcare is likely to be an important mechanism in improving the women¿s health outcomes.

In recognition of the need to better prepare doctoral candidates with teaching and learning competencies, we devised an innovative internship program in the form of a structured apprenticeship and trialed it in public health higher education. The paid internship was comprised of: (i) Mentoring from an experienced educator, (ii) Structured program of education in pedagogy and curriculum design, and (iii) Opportunities for applied experience. Eleven interns completed the apprenticeship in its first 2 years. The mixed method evaluation assessed the impact of the internship on knowledge, skills, and confidence of interns throughout the internship, and included a cost-consequence analysis. Data collection included surveys and face-to-face interviews with interns and mentors. Changes in intern knowledge and skills were analyzed by intern self-ratings pre- and post-internship on 11 performance descriptors. All interns indicated improvement in at least one area of teaching. Interviews indicated general satisfaction, however raised incompatibilities between the unstructured nature of mentoring and intern expectations and preferences. The economic analysis calculated a cost-offset associated with intern-delivered teaching activities of $58,820 (AUD, 2019). The total cost of the program was calculated to be $70,561 (comprising mentor investment AUD$20,436, intern investment AUD$15,126, scholarship ¿top-up¿ payment of $5,000 paid to each of the 7 interns AUD $35,000). This Internship is associated with positive impacts for interns across a range of domains at a net total investment of $11,741.

Purpose: To determine the prevalence and incidence of atrial fibrillation (AF) among older Australian women from 2000 to 2015, determine factors associated with AF, and to calculate risk of stroke at the time of AF diagnosis. Methods: This is a retrospective analysis of 6671 women of the 1921¿1926 birth cohort of the Australian Longitudinal Study on Women's Health, linked to data from hospital admissions to identify AF and National Death Index to determine date of death. Yearly prevalence and incidence proportions of AF, and stroke risk using CHA2DS2-VA scheme, were calculated. Factors associated with AF were assessed using logistic regression. Results: From 2000 to 2015, a total of 1827 women with AF were identified. AF prevalence increased every year as women aged from 2.71% (95% CI 1.62%¿3.80%) in 2000 among women aged 74¿79 years to 24.83% (95% CI = 23.23%¿26.44%) in 2015 among women aged 89¿94 years. The incidence proportion remained constant (between 3% and 5%) throughout the study period. Sedentary lifestyle (OR = 1.24, 95% CI = 1.04¿1.49), hypertension (OR = 1.24, 95% CI = 1.09¿1.42), arthritis (OR = 1.24, 95% CI = 1.09¿1.41), heart attack (OR = 1.62, 95% CI = 1.18¿2.24), and angina (OR = 1.39, 95% CI = 1.14¿1.70) were independently associated with AF. Mean CHA2DS2-VA score for women with AF was 3.43 (SD ± 1.23). Conclusions: The prevalence of AF reported in Australian women is among the highest compared to previous estimations from other countries and regions. According to the findings, about one in four women over the age of 90 years had AF. These women were also at high risk of stroke. This has significant public health implications especially with changing demographics of increase in the aging population. Further research is required on understanding how women with AF are treated in Australia and their health outcomes.

Objective: To assess which older Australian women had Medicare subsidized health assessments between 1999 and 2013. Methods: This study used prospective, longitudinal survey data from the 1921 to 1926 birth cohort of Australian Longitudinal Study on Women¿s Health (ALSWH) linked with Medicare Australia data on health services use. Over 11,000 Australian women were included in the study. Latent class analysis was used to identify assessment patterns over time, accounting for death, and based on three categories (¿no assessment¿; ¿assessment; ¿deceased¿) for each year between 1999 and 2013. Further analysis explored the impact of health and sociodemographic characteristics on class membership. Results: Of the women included in the latent class analysis, 37% never had any assessment and the remainder had had at least one assessment. After a steady uptake from 1999 to 2003, there was decline in uptake from 2003 onwards. A six-class model with sufficient homogeneity and reliable estimation was selected to represent assessment patterns and mortality risk, labelled as: ¿high mortality¿ rate with little chance for assessment (12.4%), ¿intermediate mortality, low assessment¿ (14.1%), ¿later mortality/low assessment¿ (13.1%), ¿later mortality, high assessment¿ (7.0%), ¿low mortality, low assessment¿ (31.8%), ¿low mortality, high assessment¿ (21.6%). Older women with certain conditions (such as diabetes, depression, heart disease) were more likely to be in the low assessment groups, and women with difficulty managing on income were more likely to be in low assessment groups. Conclusion: Distinct assessment and mortality patterns were seen, with many women not having assessment, in particular those who had certain health conditions, were taking 3+ medications, had difficulty in managing on income, needed help or were in respite care, and had caring responsibilities. The findings point to a need to promote these assessments among older women, and to reduce financial barriers, even within the context of a heavily subsidized health care system.

Objective: This study identified associations between chronic diseases (diabetes, asthma, depression, and arthritis) and workforce participation patterns with a gendered perspective. Method: We used data from 1,261 middle-aged participants of the Australian Life Histories and Health (LHH) Survey, aged 60 to 64 years in 2011. Latent class analysis identified dominant workforce patterns and associations between chronic diseases and these patterns were explored by multinomial regression models. Results: Diabetes, asthma, depression, and arthritis were less prevalent in men and women in class "mostly full-time work," compared with other workforce patterns. The odds of "mostly full-time work" were lower for men reporting depression or arthritis, whereas among women, depression was associated with "increasing part-time work" after adjusting early and adult life factors. Discussion: The results strengthen the importance of gender focused policies aimed to promote and preserve health of young and middle-aged workers, and creating supportive environment for those with chronic health issues over the life course.

Background Clozapine is the cornerstone of therapy for refractory schizophrenia; however, the potential for cardiotoxicity is an important limitation in its use. In the current analysis we sought to evaluate the long term cardiac outcomes of clozapine therapy. Methods All-cause mortality, incidence of sudden death and time to myocarditis were assessed in a cohort of patients maintained on clozapine between January 2009 and December 2015. All patients had regular electrocardiograms, complete blood count, clozapine levels and echocardiography as part of a formal protocol. Results A total of 503 patients with treatment-resistant schizophrenia were maintained on clozapine during the study period of which 93 patients (18%) discontinued therapy with 29 (6%) deaths. The incidence of sudden death and myocarditis were 2% (n¿=¿10) and 3% (n¿=¿14) respectively. Amongst patients with sudden death, 7 out of 10 (70%) were documented to have used illicit drugs prior to death, with a tendency to weight gain also noted. The mean time to myocarditis post clozapine commencement was 15¿±¿7¿days. The reduction in left ventricular ejection fraction in those with myocarditis was 11¿±¿2%. Conclusion Myocarditis and sudden cardiac death are uncommon but clinically important complications in a cohort of patients followed while maintained on clozapine undergoing regular cardiac assessment. Further studies are required to document the role of preventive measures for left ventricular dysfunction and sudden cardiac death in this population.

Background Comorbid conditions frequently coexist with asthma in older adults and can alter the natural history of asthma, complicating management and affecting overall prognosis and survival. Objectives This study investigates the impact of asthma on mortality among older women, with a specific interest in influence of comorbidities and social factors on survival of older women with asthma. Design Participants were from the Australian Longitudinal Study on Women's Health and were born between 1921 and 1926. Cox proportional hazards were used to evaluate mortality rates for women with and without asthma, after adjustment for comorbidities and other factors. Results Of 10,413 women aged 73¿78, 829 (8%) reported having been diagnosed by a doctor for asthma. Women with asthma had a higher likelihood of heart disease, hypertension, thrombosis, bronchitis/emphysema, osteoporosis and major illnesses (p¿<¿0.0001). Asthma was associated with increased risk of death (HR¿=¿1.31, 95%CI 1.18¿1.45, p¿<¿0.0001). After adjusting for age, demographic factors, comorbidities, risk factors, residential area and social support, women with asthma retained a 17% increased risk of death compared to women without asthma (HR¿=¿1.17, 95%CI 1.03¿1.32, p¿=¿0.016). Conclusion Older women with asthma have a higher rate of mortality compared with other women of the same age. This increased risk of death remains after age, demographic factors, comorbidities, risk factors, residential area and social support have been taken into account.

Population ageing and its future implications for governments and individuals have been central to much policy debate and research targeted to retain older people in the workforce. This study identified workforce participation patterns across the adult life course for women and men entering later life, and explored the influences of various early and adult life socio-demographic circumstances. Data were collected from 1261 men and women aged 60 to 64. years in the Life History and Health (LHH) Survey (a sub-study of the Sax Institute's 45 and Up Study, Australia) in 2010-11. LHH provides detailed information on personal histories of paid work, socio-economic resources from childhood (number of books and father's occupation) and adult life factors such as educational attainment, marital histories, childcare and informal caring. Latent class analysis (LCA) was undertaken to identify patterns of workforce participation for participants across their adult life. Significant gender differences were confirmed. Further analysis (LCA with covariates) showed that women who reported having books during childhood, and those who had post-school qualification, were more likely to have mostly been in paid work and less likely to have not been in paid work; while ever partnered women had significantly higher odds of increasing part time work over time. Men who had reported ever having had informal caring activities were likely to have had decreasing participation in paid work over time, and were highly likely to be not in paid work after 55. years. Ever partnered status was protective for being in paid work for men. These findings indicate the need for gender-specific policies and strategies to enable continued workforce participation throughout adult life and into later working years, particularly for people who had fewer social or economic opportunities earlier in life.

Thalassemia major is one of the most common genetic disorders in Pakistan and over five thousand new patients are added in the pool annually. This familial disease has both medical and social implications, and therefore there is a need to assess the magnitude of beta-Thalassemia trait amongst family members of Thalassemia major patients. This cross-sectional descriptive study enrolled 674 blood samples from first degree relatives of registered patients of Thalassemia major at Sir Ganga Ram Hospital, Lahore. Peripheral blood smears were studied for abnormal morphology findings of microcytosis, hypochromia, poikilocytosis (tear drops, target cells) and Erythrocyte indices (haemoglobin, RBCs, mean corpuscular haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin concentration) and Hb electrophoretic (HbA, HbA2, & HbF). Hb electrophoresis showed 61% of the study subjects had haemoglobinopathies. Frequency of beta-Thalassemia trait was highest followed by beta-Thalassemia major, HbE trait, HbD Punjab and Hb intermedia. Findings strongly suggest screening for beta-Thalassemia trait in families of Thalassemia major patients.