scholarly journals Broad Spectrum Epidemiological Contribution of Cannabis, Tobacco and Alcohol to the Teratological Profile of Northern New South Wales: Geospatial and Causal Inference Analysis

2020 ◽  
Author(s):  
Albert Stuart Reece ◽  
Gary Kenneth Hulse
Keyword(s):  
Body Wall ◽  
Septal Defect ◽  
New South ◽  
Ductus Arteriosus ◽  
New South Wales ◽  
Prevalence Ratio ◽  
Population Level ◽  
Cannabis Use ◽  
Anal Stenosis ◽  
South Wales

Abstract Background. Whilst cannabis commercialization is occurring rapidly guided by highly individualistic public narratives, evidence that all congenital anomalies (CA) increase alongside cannabis use in Canada, a link with 21 CA’s in Hawaii, and rising CA’s in Colorado indicate that transgenerational effects can be significant and impact public health. It was therefore important to study Northern New South Wales (NNSW) where cannabis use is high.Methods. Design: Cohort. 2008–2015. Setting: NNSW and Queensland (QLD), Australia. Participants. Whole populations. Exposures. Tobacco, alcohol, cannabis. Source: National Drug Strategy Household Surveys 2010, 2013. Main Outcomes. CA Rates. NNSW-QLD comparisons. Geospatial and causal regression.Results. Cardiovascular, respiratory and gastrointestinal anomalies rose with falling tobacco and alcohol but rising cannabis use rates across Queensland. Maternal age NNSW-QLD was not different (2008–2015: 4,265/22,084 v. 96,473/490,514 > 35 years, Chi.Sq.=1.687, P = 0.194). A higher rate of NNSW cannabis-related than cannabis-unrelated defects occurred (prevalence ratio (PR) = 2.13, 95%C.I. 1.80–2.52, P = 3.24 × 10− 19). CA’s rose more potently with rising cannabis than with rising tobacco or alcohol use. Exomphalos and gastroschisis had the highest NNSW:QLD PR (6.29(2.94–13.48) and 5.85(3.54–9.67)) and attributable fraction in the exposed (84.11%(65.95–92.58%) and 82.91%(71.75–89.66%), P = 2.83 × 10− 8 and P = 5.62 × 10− 15). In multivariable geospatial models cannabis was significantly linked with cardiovascular (atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus), genetic (chromosomal defects, Downs syndrome), gastrointestinal (small intestinal atresia), body wall (gastroschisis, diaphragmatic hernia) and other (hypospadias) (AVTPCDSGDH) CA’s. In linear modelling cannabis use was significantly linked with anal stenosis, congenital hydrocephalus and Turner syndrome (ACT) and was significantly linked in borderline significant models (model P < 0.1) with microtia, microphthalmia, and transposition of the great vessels. At robust and mixed effects inverse probability weighted multivariable regression cannabis was related to 18 defects. E-Values in spatial models were generally > 1.3 ranging up to 3.8 × 1030 making uncontrolled confounding unlikely.Conclusions. These results suggest that population level CA’s react more strongly to small rises in cannabis use than tobacco or alcohol; cardiovascular, chromosomal, body wall and gastrointestinal CA’s rise significantly with small increases in cannabis use; that cannabis is a bivariate correlate of AVTPCDSGDH and ACT anomalies, is robust to adjustment for other substances; and is causal.

scholarly journals Broad Spectrum Epidemiological Contribution of Cannabis and Other Substances to the Teratological Profile of Northern New South Wales: Geospatial and Causal Inference Analysis

2020 ◽  
Author(s):  
Albert Stuart Reece ◽  
Gary Kenneth Hulse
Keyword(s):  
Body Wall ◽  
Septal Defect ◽  
New South ◽  
Ductus Arteriosus ◽  
New South Wales ◽  
Prevalence Ratio ◽  
Cannabis Use ◽  
Anal Stenosis ◽  
South Wales ◽  
Other Substances

Abstract Background: Whilst cannabis commercialization is occurring rapidly guided by highly individualistic public narratives, evidence that all congenital anomalies (CA) increase alongside cannabis use in Canada, a link with 21 CA’s in Hawaii, and rising CA’s in Colorado indicate that transgenerational effects can be significant and impact public health. It was therefore important to study Northern New South Wales (NNSW) where cannabis use is high. Methods: Design: Cohort. 2008-2015. Setting: NNSW and Queensland (QLD), Australia. Participants. Whole populations. Exposures. Tobacco, alcohol, cannabis. Source: National Drug Strategy Household Surveys 2010, 2013. Main Outcomes. CA Rates. NNSW-QLD comparisons. Geospatial and causal regression. Results: Cardiovascular, respiratory and gastrointestinal anomalies rose with falling tobacco and alcohol but rising cannabis use rates across Queensland. Maternal age NNSW-QLD was not different (2008-2015: 4265/22084 v. 96473/490514 >35 years/total, Chi.Sq.=1.687, P=0.194). A higher rate of NNSW cannabis-related than cannabis-unrelated defects occurred (prevalence ratio (PR)=2.13, 95%C.I. 1.80-2.52, P=3.24x10-19). CA’s rose more potently with rising cannabis than with rising tobacco or alcohol use. Exomphalos and gastroschisis had the highest NNSW:QLD PR (6.29(2.94-13.48) and 5.85(3.54-9.67)) and attributable fraction in the exposed (84.11%(65.95-92.58%) and 82.91%(71.75-89.66%), P=2.83x10-8 and P=5.62x10-15). In multivariable geospatial models cannabis was significantly linked with cardiovascular (atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus), genetic (chromosomal defects, Downs syndrome), gastrointestinal (small intestinal atresia), body wall (gastroschisis, diaphragmatic hernia) and other (hypospadias) (AVTPCDSGDH) CA’s. In linear modelling cannabis use was significantly linked with anal stenosis, congenital hydrocephalus and Turner syndrome (ACT) and was significantly linked in borderline significant models (model P<0.1) with microtia, microphthalmia, and transposition of the great vessels. At robust and mixed effects inverse probability weighted multivariable regression cannabis was related to 18 defects. 16/17 E-Values in spatial models were >1.25 ranging up to 5.2x1013 making uncontrolled confounding unlikely. Conclusions: These results suggest that population level CA’s react more strongly to small rises in cannabis use than tobacco or alcohol; cardiovascular, chromosomal, body wall and gastrointestinal CA’s rise significantly with small increases in cannabis use; that cannabis is a bivariate correlate of AVTPCDSGDH and ACT anomalies, is robust to adjustment for other substances; and is causal.

scholarly journals Broad Spectrum epidemiological contribution of cannabis and other substances to the teratological profile of northern New South Wales: geospatial and causal inference analysis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Albert Stuart Reece ◽  
Gary Kenneth Hulse
Keyword(s):  
Body Wall ◽  
Septal Defect ◽  
New South ◽  
Ductus Arteriosus ◽  
New South Wales ◽  
Prevalence Ratio ◽  
Cannabis Use ◽  
Anal Stenosis ◽  
South Wales ◽  
Other Substances

Abstract Background Whilst cannabis commercialization is occurring rapidly guided by highly individualistic public narratives, evidence that all congenital anomalies (CA) increase alongside cannabis use in Canada, a link with 21 CA’s in Hawaii, and rising CA’s in Colorado indicate that transgenerational effects can be significant and impact public health. It was therefore important to study Northern New South Wales (NNSW) where cannabis use is high. Methods Design: Cohort. 2008–2015. Setting: NNSW and Queensland (QLD), Australia. Participants. Whole populations. Exposures. Tobacco, alcohol, cannabis. Source: National Drug Strategy Household Surveys 2010, 2013. Main Outcomes. CA Rates. NNSW-QLD comparisons. Geospatial and causal regression. Results Cardiovascular, respiratory and gastrointestinal anomalies rose with falling tobacco and alcohol but rising cannabis use rates across Queensland. Maternal age NNSW-QLD was not different (2008–2015: 4265/22084 v. 96,473/490514 > 35 years/total, Chi.Sq. = 1.687, P = 0.194). A higher rate of NNSW cannabis-related than cannabis-unrelated defects occurred (prevalence ratio (PR) = 2.13, 95%C.I. 1.80–2.52, P = 3.24 × 10− 19). CA’s rose more potently with rising cannabis than with rising tobacco or alcohol use. Exomphalos and gastroschisis had the highest NNSW:QLD PR (6.29(2.94–13.48) and 5.85(3.54–9.67)) and attributable fraction in the exposed (84.11%(65.95–92.58%) and 82.91%(71.75–89.66%), P = 2.83 × 10− 8 and P = 5.62 × 10− 15). In multivariable geospatial models cannabis was significantly linked with cardiovascular (atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus), genetic (chromosomal defects, Downs syndrome), gastrointestinal (small intestinal atresia), body wall (gastroschisis, diaphragmatic hernia) and other (hypospadias) (AVTPCDSGDH) CA’s. In linear modelling cannabis use was significantly linked with anal stenosis, congenital hydrocephalus and Turner syndrome (ACT) and was significantly linked in borderline significant models (model P < 0.1) with microtia, microphthalmia, and transposition of the great vessels. At robust and mixed effects inverse probability weighted multivariable regression cannabis was related to 18 defects. 16/17 E-Values in spatial models were > 1.25 ranging up to 5.2 × 1013 making uncontrolled confounding unlikely. Conclusions These results suggest that population level CA’s react more strongly to small rises in cannabis use than tobacco or alcohol; cardiovascular, chromosomal, body wall and gastrointestinal CA’s rise significantly with small increases in cannabis use; that cannabis is a bivariate correlate of AVTPCDSGDH and ACT anomalies, is robust to adjustment for other substances; and is causal.

scholarly journals Broad Spectrum Epidemiological Contribution of Cannabis and Other Substances to the Teratological Profile of Northern New South Wales: Geospatial and Causal Inference Analysis 

2020 ◽  
Author(s):  
Albert Stuart Reece ◽  
Gary Kenneth Hulse
Keyword(s):  
Body Wall ◽  
Septal Defect ◽  
New South ◽  
Ductus Arteriosus ◽  
New South Wales ◽  
Prevalence Ratio ◽  
Cannabis Use ◽  
Anal Stenosis ◽  
South Wales ◽  
Other Substances

Abstract Background. Whilst cannabis commercialization is occurring rapidly guided by highly individualistic public narratives, evidence that all congenital anomalies (CA) increase alongside cannabis use in Canada, a link with 21 CA’s in Hawaii, and rising CA’s in Colorado indicate that transgenerational effects can be significant and impact public health. It was therefore important to study Northern New South Wales (NNSW) where cannabis use is high.Methods. Design: Cohort. 2008-2015. Setting: NNSW and Queensland (QLD), Australia. Participants. Whole populations. Exposures. Tobacco, alcohol, cannabis. Source: National Drug Strategy Household Surveys 2010, 2013. Main Outcomes. CA Rates. NNSW-QLD comparisons. Geospatial and causal regression. Results. Cardiovascular, respiratory and gastrointestinal anomalies rose with falling tobacco and alcohol but rising cannabis use rates across Queensland. Maternal age NNSW-QLD was not different (2008-2015: 4265/22084 v. 96473/490514 >35 years/total, Chi.Sq.=1.687, P=0.194). A higher rate of NNSW cannabis-related than cannabis-unrelated defects occurred (prevalence ratio (PR)=2.13, 95%C.I. 1.80-2.52, P=3.24x10-19). CA’s rose more potently with rising cannabis than with rising tobacco or alcohol use. Exomphalos and gastroschisis had the highest NNSW:QLD PR (6.29(2.94-13.48) and 5.85(3.54-9.67)) and attributable fraction in the exposed (84.11%(65.95-92.58%) and 82.91%(71.75-89.66%), P=2.83x10-8 and P=5.62x10-15). In multivariable geospatial models cannabis was significantly linked with cardiovascular (atrial septal defect, ventricular septal defect, tetralogy of Fallot, patent ductus arteriosus), genetic (chromosomal defects, Downs syndrome), gastrointestinal (small intestinal atresia), body wall (gastroschisis, diaphragmatic hernia) and other (hypospadias) (AVTPCDSGDH) CA’s. In linear modelling cannabis use was significantly linked with anal stenosis, congenital hydrocephalus and Turner syndrome (ACT) and was significantly linked in borderline significant models (model P<0.1) with microtia, microphthalmia, and transposition of the great vessels. At robust and mixed effects inverse probability weighted multivariable regression cannabis was related to 18 defects. 16/17 E-Values in spatial models were >1.25 ranging up to 5.2x1013 making uncontrolled confounding unlikely.Conclusions. These results suggest that population level CA’s react more strongly to small rises in cannabis use than tobacco or alcohol; cardiovascular, chromosomal, body wall and gastrointestinal CA’s rise significantly with small increases in cannabis use; that cannabis is a bivariate correlate of AVTPCDSGDH and ACT anomalies, is robust to adjustment for other substances; and is causal.

The breeding behaviour of the endangered regent honeyeater, Xanthomyza phrygia, near Armidale, New South Wales

1998 ◽  
Vol 46 (2) ◽  
pp. 153 ◽  
Author(s):  
Damon L. Oliver
Keyword(s):  
New South ◽  
New South Wales ◽  
Population Level ◽  
Similar Rate ◽  
Nest Construction ◽  
Aggressive Interactions ◽  
Breeding Behaviour ◽  
South Wales ◽  
The Mean ◽  
Breeding Seasons

The regent honeyea ter, Xanthomyza phrygia, is an endangered woodland bird whose range and population size have decreased in the last thirty years. Suggested reasons for this decline include abnormal breeding behaviour, poor reproductive output, and excessive inter- and intra-specific aggression. This study investigated the breeding behaviour and aggressive interactions of regent honeyeaters during the nest construction, incubation, nestling, and fledgling stages in two consecutive breeding seasons in the Bundarra–Barraba region near Armidale, New South Wales. The female was entirely responsible for nest construction and incubation, which is typical of many honeyeaters. Both parents fed the nestlings, and at a similar rate, although only the female brooded chicks on the nest. Both parents fed the fledglings. The mean frequency at which nestlings (23 times per hour) and fledglings (29 times per hour) were fed is the highest published rate of any non-cooperative honeyeater. Breeding males were involved in significantly more aggressive interactions with conspecifics and other nectarivores than were females, although the overall percentage of day-time spent in aggression for both sexes was low (2.5%). It appears that abnormal breeding behaviour, poor reproductive effort, or excessive aggression are not experienced by this species in northern New South Wales, and that other factors are likely to be responsible for its current low population level.

scholarly journals Developmental vulnerability at age five among children who enter and progress through the child protection system in New South Wales, Australia: a cross-sectoral data linkage study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Kathleen Falster ◽  
Mark Hanly ◽  
Rhiannon Pilkington ◽  
Marilyn Chilvers ◽  
Elizabeth Whittaker ◽  
...  
Keyword(s):  
Early Childhood ◽  
Child Protection ◽  
Data Linkage ◽  
New South ◽  
New South Wales ◽  
Population Level ◽  
Protection System ◽  
Similar Data ◽  
Targeted Interventions ◽  
South Wales

IntroductionA recent independent review of the child protection system in New South Wales (NSW), Australia, highlighted the need for whole-of-government reform to improve outcomes for children at risk of, or experiencing, maltreatment. Population-level evidence on outcomes of children who enter and progress through the child protection system is currently lacking. Objectives and ApproachWe aimed to quantify developmental vulnerability at age five among children who enter and progress through the child protection system during early childhood to demonstrate the value of cross-sectoral data linkage to inform and evaluate policy at a population-level. We used Australian Early Development Census (AEDC) data linked to cross-sectoral population datasets in NSW, including birth registrations, perinatal, and child protectionnotification and out-of-home care (OOHC) placement data. Linked AEDC data, collected in 2009 and 2012, areavailable for 153,670 NSW children. Socio-demographic and perinatal characteristics available in the linked data were used to characterise the population. Results21,179 (13.9%) children had ≥1 ‘screened in’ notification, 4927 (3.2%) had ≥1 substantiated abuse and neglect notification, and 2177 (1.4%) had ≥1 OOHC placement before their fifth birthday. Indicators of disadvantage and adverse birth outcomes were more common among children who progressed to higher levels of the child protection system. The proportion developmentally vulnerable on ≥1 domains of the AEDC increased for children who entered and progressed through the child protection system; from 21% of children with no contact with child protection before age five, to 39% of children with ≥1 ‘screened in’ notification, 50% with ≥1 substantiated notification, and 54% with ≥1 OOHC placement before their fifth birthday. Comparison of findings from other Australian jurisdictions with similar data will be discussed. Conclusion/ImplicationsThis study demonstrates there is scope to improve developmental outcomes through targeted interventions among children who become known to child protection during early childhood in NSW. Moreover, it illustrates that cross-sectoral data linkage can be used to inform and evaluate policy reforms to drive better outcomes for vulnerable children.

scholarly journals Is gentamicin a viable therapeutic option for treating resistant Neisseria gonorrhoeae in New South Wales?

2021 ◽  
Vol 45 ◽  
Author(s):  
Benjamin H Armstrong ◽  
Athena Limnios ◽  
David A Lewis ◽  
Tiffany Hogan ◽  
Ratan Kundu ◽  
...  
Keyword(s):  
Neisseria Gonorrhoeae ◽  
Large Scale ◽  
New South ◽  
Therapeutic Option ◽  
New South Wales ◽  
Newborn Health ◽  
Population Level ◽  
Clinical Isolates ◽  
National Guidelines ◽  
South Wales

The key issues with Neisseria gonorrhoeae infections, in Australia and elsewhere, are coincident increases in disease rates and in antimicrobial resistance (AMR), although these factors have not been shown to be correlated. Despite advances in diagnosis, control of this disease remains elusive, and incidence in Australia continues to increase. Of the Australian jurisdictions, New South Wales (NSW) has the highest N. gonorrhoeae notifications, and over the five-year period 2015–2019, notifications in NSW have increased above the national average (by 116% versus 85%, respectively). Gonococcal disease control is reliant on effective antibiotic regimens. However, escalating AMR in N. gonorrhoeae is a global health priority, as the collateral injury of untreated infections has substantive impacts on sexual and newborn health. Currently, our first-line therapy for gonorrhoea is also our last line, with no ideal alternative identified. Despite some limitations, gentamicin is licensed and readily available in Australia, and is proposed for treatment of resistant N. gonorrhoeae in national guidelines; however, supportive published microbiological data are lacking. Analysis of gonococcal resistance patterns within Australia for the period 1991–2019, including 35,000 clinical isolates from NSW, illustrates the establishment and spread of population-level resistance to all contemporaneous therapies. An analysis of gentamicin susceptibility on 2,768 N. gonorrhoeae clinical isolates from NSW, for the period 2015–2020, demonstrates that the median minimum inhibitory concentration (MIC) for gentamicin in NSW has remained low, at 4.0 mg/L, and resistance was not detected in any isolate. There has been no demonstration of MIC drift over time (p = 0.91, Kruskal-Wallis test), nor differences in MIC distributions according to patients’ sex or site of specimen collection. This is the first large-scale evaluation of gentamicin susceptibility in N. gonorrhoeae in Australia. No gentamicin resistance was detected in clinical isolates, 2015–2020, hence this is likely to be an available treatment option for resistant gonococcal infections in NSW.

A system dynamics modelling approach to studying the increasing prevalence of people with intellectual developmental disorders in New South Wales

2016 ◽  
Vol 40 (3) ◽  
pp. 235 ◽  
Author(s):  
Lynette Lee ◽  
Mark Heffernan ◽  
Geoffrey McDonnell ◽  
Stephanie D. Short ◽  
Vasi Naganathan
Keyword(s):  
Health Service ◽  
System Dynamics ◽  
Developmental Disorders ◽  
New South ◽  
New South Wales ◽  
Age Groups ◽  
Prevalence Ratio ◽  
Service Planning ◽  
Self Report ◽  
South Wales

Objective The aims of this study were to estimate the prevalence count of people with intellectual developmental disorders (IDD) in New South Wales (NSW) in 2003, by age groups, and to forecast their prevalence until 2043. Methods Administrative data obtained from NSW government departments of education, pensions, health and disability were used to profile the number of people whose characteristics met the criteria for ‘intellectual developmental disorders’ who had received services in 2003. These figures were compared with published tables of NSW data from the national self-report Survey of Disability, Ageing and Carers (SDAC) of 2003 to estimate the likely prevalence of people with intellectual developmental disorders, by age groups in that year. The results were then used as baseline figures in a computational system dynamics model of the aging chain of people with these disorders, built to project prevalence to 2043. Results The number of people who met the criteria for having intellectual developmental disorder in NSW in 2003 was estimated to be 57000 (a ratio of 85 per 10000), with 32000 aged 0–15 years, 15000 aged 16–39 years, 9000 aged 40–64 years and 1000 aged 65+ years. Using these figures as baseline, the computer simulation predicted a total increase to 77225 people in 2013 and 135905 people by 2043. By 2043, the number of children with intellectual developmental disorders will have doubled, from 32000 to 59480, and the number of adults will have tripled, from 25000 to 76420. Conclusions This modelling technique forecast an increase in the prevalence count of people with intellectual developmental disorders in NSW over the period 2003–43 from 57000 (85 per 10000) to 135905 (135 per 10000). These predictions may have important implications for the planning of specialist health services for this group of people. What is known about the topic? The prevalence ratio of people with intellectual developmental disorders is quoted at lying between 1% and 2% of the Australian population, depending on the definition adopted. It is known that life expectancy for this group of people is increasing. Many people with intellectual developmental disorders have multiple service demands and there is a need to understand the prevalence count in various age groups in order to plan effectively for their health service needs. What does this paper add? This paper confirms a NSW prevalence ratio of people with intellectual developmental disorders of approximately 0.85% for the purposes of specialist health service planning at the beginning of the 21st century, and this is predicted to increase to 1.35% over a 40-year period. The paper demonstrates that there will be significant growth in the number of adults surviving to old age between 2003 and 2043. What are the implications for practitioners? It is known that as people with intellectual developmental disorders age, their health promoting care needs increase, as do their dependencies on special supports. Planning for the allocation of resources associated with the welfare and healthcare of people with intellectual developmental disorders may need to be focused on this anticipated increase in the number of older people with the condition.

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