Papers by Alexandra M Clavarino
Research Square (Research Square), Jun 14, 2023
Oral mucositis (OM) is a common complication in haematopoietic stem cell transplantation (HSCT). ... more Oral mucositis (OM) is a common complication in haematopoietic stem cell transplantation (HSCT). Polaprezinc, an anti-ulcer drug, has been shown to be effective to prevent OM in several studies when administered topically and systemically. This study aimed to evaluate the effectiveness of topical polaprezinc in patients undergoing HSCT. This was an open-label randomised clinical trial comparing polaprezinc and sodium bicarbonate mouthwashes for the prevention of severe OM in HSCT patients. Adult patients who received conditioning regimens at moderate to high risk of developing OM were included. The primary endpoint was the incidence of severe (WHO grade 3-4) OM. The secondary endpoints included duration of grade 3-4 OM, incidence and duration of Grade 2-4 OM, patient-reported pain and functional limitations. In total, 108 patients (55 test arm, 53 control arm) were randomised. There was no difference in the incidence of grade 3 to 4 OM (35% test arm versus 36% control arm). The secondary endpoints were not signi cantly different. In both arms, patients reported more throat pain compared to mouth pain. Topical polaprezinc had no effect in prevention of OM in HSCT patients. Further research is required to evaluate the effects of systemic polaprezinc. The OM assessment tool needs to be reviewed as throat mucositis was a main issue in this study.
Australian Journal of Rural Health, Jun 28, 2008
This study examines the impact of travelling for treatment on cancer patients and their families.... more This study examines the impact of travelling for treatment on cancer patients and their families. Twenty-eight consecutive cancer patients, who were receiving radiation therapy treatment and 19 family carers, completed a structured needs assessment questionnaire and an in-depth interview. Both patients and carers reported moderate to high levels of unmet psychological need. Carers were found to have higher levels of anxiety than patients, although both groups had higher anxiety levels than the general population. Taking more responsibility for household tasks and organising new living arrangements for the family were the most frequently identified demands of a dual burden of caring. Nearly 40% of carers reported some disruption to their schedule and half reported experiencing financial difficulties. The qualitative interviews highlight the disruption that parents and children experience under the present system, particularly in relation to the demands of family life and the need to maintain some level of continuity and security for children.
Research Square (Research Square), Mar 11, 2022
Oral mucositis and taste disturbance are common complications during haematopoietic stem cell tra... more Oral mucositis and taste disturbance are common complications during haematopoietic stem cell transplantation (HSCT). This study aimed to review the incidence of severe mucositis and taste disturbance in patients undergoing different HSCT regimens. This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with posttransplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, taste disturbance, use of total parenteral nutrition (TPN) and patientcontrolled analgesia (PCA) were collected. Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI) based regimens cyclophosphamide/ TBI (CyTBI) (71%) and udarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced intensity udarabine/ melphalan (FluMel) (43%) and carmustine/ etoposide/ cytarabine/ melphalan (BEAM) autologous HSCT (41%). In contrast, Grade 3-4 oral mucositis was less common in reduced intensity haploidentical regimen melphalan/ udarabine/ TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. Taste disturbance was common regardless of the regimens (89%, range 71-95%). Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.
Palliative Medicine, Dec 1, 2003
The purpose of this study was to compare the physical, psychological and social dimensions associ... more The purpose of this study was to compare the physical, psychological and social dimensions associated with quality-of-life outcomes over the last year of life, between advanced cancer users and nonusers of complementary and alternative medicine. One hundred and eleven patients were identified through Queensland Cancer Registry records, and followed up every four to six weeks until close to death using standardized protocols. Outcome measures were symptom burden, psychological distress, subjective wellbeing, satisfaction with conventional medicine and need for control over treatment decisions. At the initial interview, 36 (32%) participants had used complementary/alternative medicine the previous week; mainly vitamins, minerals and tonics and herbal remedies. Among all participants, 53 (48%) used at least one form of complementary/alternative medicine over the study period. Only six (11%) visited alternative practitioners on a regular basis. Overall, complementary/alternative medicine users reported higher levels of anxiety and pain, less satisfaction with conventional medicine and lower need for control over treatment decisions compared with nonusers. These differences tend to change as death approaches. A more rigorous assessment of complementary/alternative medicine use, psychological distress, pain and subjective wellbeing among patients with advanced cancer is needed in the clinical setting.
Pharmacy, Oct 18, 2022
Pharmacist-managed therapeutic drug monitoring (TDM) services have demonstrated positive outcomes... more Pharmacist-managed therapeutic drug monitoring (TDM) services have demonstrated positive outcomes in the literature, including reduced duration of therapy and decreased incidence of the adverse effects of drug therapy. Although the evidence has demonstrated the benefits of these TDM services, this has predominately been within international healthcare systems. The extent to which pharmacist-managed TDM services exist within Australia, and the roles and responsibilities of the pharmacists involved compared to their counterparts in other countries, remains largely unknown. A cross-sectional online survey was conducted evaluating pharmacist-managed TDM programs within Australian hospital and healthcare settings. Pharmacist perceptions were also explored about the strengths, weaknesses, opportunities, and barriers associated with implementing a pharmacist-managed TDM service. A total of 92 surveys were returned, which represents a response rate of 38%. Pharmacist-managed TDM programs were present in 15% of respondents. It is only in the minority of hospitals where there is a pharmacist-managed service, with pharmacists involved in recommending pathology and medication doses. The programs highlighted improved patient outcomes but had difficulty maintaining the educational packages and training. For hospitals without a service, a lack of funding and time were highlighted as barriers. Based on the findings of this survey, there is minimal evidence of pharmacist-managed TDM models within Australian hospital and health services. A standardized national approach to pharmacist-managed TDM services and recognition of this specialist area for pharmacists could be a potential solution to this.
Supportive Care in Cancer, Nov 25, 2021
Purpose Oral mucositis is a common complication in patients undergoing hematopoietic stem cell tr... more Purpose Oral mucositis is a common complication in patients undergoing hematopoietic stem cell transplantation. Accurate oral mucositis grading is essential for both clinical practice and oral mucositis research. This study aimed to evaluate the accuracy of daily oral mucositis grading by nurses in a tertiary hospital in Australia. Methods A retrospective study was undertaken to review the daily patient oral assessment record, including diet, pain, erythema, ulceration and the oral mucositis grade based on World Health Organization (WHO) oral mucositis grading scale. The accuracy of the grade was determined by the observations recorded, and reasons for inaccuracy were documented. Any repetition of the same error in the same patient was noted. Results In total, 6841 oral assessments in 373 patients, conducted between 2017 and 2020, were reviewed. A total of 70% ( N = 4781) were graded correctly. Of these, 64% ( N = 3043) were grade 0. When the grade 0 scores were excluded, the accuracy of grading was reduced to 46% ( N = 1738). Common reasons for incorrect grading included: unable to grade due to diet not specified, no ulceration and no pain was scored grade 1, no ulceration was scored as grade 2–4, oral intake was not taken into account, and pain without ulcer was scored 0. A total of 77% of the errors were repeated in the same patient on consecutive days. Conclusions Our results suggest there is frequent inaccurate evaluation of oral mucositis and a need for nurse training to accurately assess oral mucositis.
Supportive Care in Cancer, Aug 26, 2022
Purpose Oral mucositis is a common complication during haematopoietic stem cell transplantation (... more Purpose Oral mucositis is a common complication during haematopoietic stem cell transplantation (HSCT). This study aimed to assess the incidence of severe mucositis in patients undergoing different HSCT regimens. Methods This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected. Results Grade 3-4 oral mucositis was common in myeloablative total body irradiation (TBI)-based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced-intensity fludarabine/ melphalan (FluMel) (43%) and carmustine/etoposide/cytarabine/melphalan (BEAM) autologous HSCT (41%). In contrast, grade 3-4 oral mucositis was less common in reduced-intensity haploidentical regimen melphalan/fludarabine/TBI with PTCy (19%), all non-myeloablative regimens (0-9%) and high-dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. Conclusions Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.
Journal of Tropical Pediatrics, 2012
Objective: This study aimed to compare the association between maternal intimate partner violence... more Objective: This study aimed to compare the association between maternal intimate partner violence and under-five mortality. Methods: Matched case-control study was conducted from May to June 2011. A sample of 286 cases and 572 controls were randomly selected from East Wollega Zone, West Ethiopia. Results: Among cases, 72.7% ever experienced controlling behaviors when compared to 62.4% for controls. All forms of maternal intimate partner violence were experienced by 61.9% of cases and 50.9% of controls. Controlling behavior in marriage and experiences of all forms of intimate partner violence during lifetime were more than four [adjusted odds ratio (AOR) 4.27, 95% confidence interval (CI) 0.97-18.89), and two (AOR ¼ 2.55, 95% CI 1.66-3.92) times as likely to be associated with under-five mortality. Conclusion: Maternal intimate partner violence victimization is strongly associated with under-five mortality. Involving men in maternal and child health programs could be one strategy to address the issue of intimate partner violence against women.
Australian and New Zealand Journal of Psychiatry, 2007
![Research paper thumbnail of Pregnancy loss and psychiatric disorders in young men and women: Results from Australian longitudinal cohort study [Conference Abstract]](https://attachments.academia-assets.com/115332347/thumbnails/1.jpg)
Asian Journal of Psychiatry, 2011
Recent evidence suggests induced abortion may be associated with later psychiatric disorders in y... more Recent evidence suggests induced abortion may be associated with later psychiatric disorders in young women. 1-3 Such findings may question one of the main orthodoxies underpinning legalised abortion, that of preventing adverse psychiatric outcomes after an unwanted pregnancy. 2 It has been observed that the associations can be explained by previous depression or drug misuse, or that the rates of psychiatric morbidity reported after abortion are no different than expected in young women of childbearing age. 4-7 Alternatively, psychiatric disorders after abortion may be a result of the experience of pregnancy loss in general, rather than being specific to induced abortion. Miscarriage and pregnancy are associated with significant psychiatric morbidity. Anxiety, depression and substance use disorders are associated with miscarriage, 8 and the risk of severe psychosis increases for some women during pregnancy. 9 To date, no population study has directly compared psychiatric outcomes in women after abortion and miscarriage. This study used prospective data to examine the associations between pregnancy loss, whether from induced abortion or spontaneous miscarriage, and a range of DSM-IV 10 psychiatric disorders assessed at age 21 years.
Journal of Psychiatric Research, Sep 1, 2019
Public Health, May 1, 2017
Objectives: Considerable evidence suggests maternal psychopathology influences that of their offs... more Objectives: Considerable evidence suggests maternal psychopathology influences that of their offspring. The probability of a reverse causal pathway has been only rarely considered but is a concern, given around 10% of children manifest mental impairment during their early years. This study determines the extent to which child behavior problems at ages 5 and 14 years are associated with mothers' mental health at 21 years post birth. Study design: Longitudinal study. Methods: Data were taken from a sample of 3650 women from Mater and University of Queensland Study of Pregnancy birth cohort. Women's mental health was measured using the Mental Disorder Screening Tool at 21 years post birth. The Child Behavior Check List was used to measure internalizing, combined social/attention/thought disorder, and aggression at the age of 5 and 14 years. Logistic regression was used to derive odds ratios and 95% confidence intervals. A number of confounders were used to test for independence. Results: Following all adjustments, child internalizing behaviors and combined social/ attention/thought disorder at 5 years, and all measures of child behavior problem at 14 years were associated with mothers meeting criteria for mental health impairment at 21 years post birth. Moreover mothers of children with behavior problems at 14 years were approximately 2e3 times more likely to these meet these criteria. Conclusions: Mothers of children with behavior problems at 5 and 14 years of age were more likely to have mental health impairment at 21 years post birth. Child health professionals should be cognizant of the motherechild relationship having mutual mental health vulnerability.
Journal of Epidemiology, 2016
Background: To identify patterns of loss to follow-up and baseline predictors of each pattern. Me... more Background: To identify patterns of loss to follow-up and baseline predictors of each pattern. Methods: The Mater-University Study of Pregnancy collected baseline information for 7718 pregnant women who attended Mater Hospital in Brisbane, Australia, from 1981 through 1983. Follow-up data for 6753 eligible participants were collected at 6 months, 5 years, 14 years, 21 years, and 27 years after giving birth. Participants were partitioned into groups of 'Always Responders', 'Returners', 'Leavers', 'Intermittents', and 'Never Responders'. Multinomial logistic regression was used to simultaneously compare baseline characteristics of the last four groups with 'Always Responders'. Results: Being younger, less educated, having no partner, and living in rented housing were associated with being a 'Returner'. Not owning housing, receiving welfare benefits, and being younger, less educated, not married, a smoker, an Aboriginal/Islander, and born in a non-English-speaking country were associated with being a 'Leaver', an 'Intermittent', or a 'Never-responder'. Having higher mental health score and drinking before pregnancy were associated with being a 'Leaver' or an 'Intermittent'. Being unemployed and not physically active were associated with being a 'Leaver' or 'Never Responder'. The groups 'Leavers' and 'Never Responders' were the most different from the 'Always Responders'. The group that was most similar to 'Always Responders' was the 'Returners'. Conclusions: Patterns of loss to follow-up should be considered in the application of missing data techniques, where researchers make assumptions about the characteristics of those subjects who do not respond to assess the type of missing data. This information can be used to prevent individuals who are at high risk of dropping out of a study from doing so.
Women and Birth, Feb 1, 2018
Nicotine & Tobacco Research, Mar 15, 2019
OBJECTIVE A prospective record-linkage analysis to examine whether notified and/or substantiated ... more OBJECTIVE A prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment is associated with the prevalence and persistence of smoking in early adulthood. METHODS The sample consisted of 3758 participants enrolled in a population-based birth cohort study in Brisbane, Australia who were followed up at both 14 and 21 years of age. Suspected experience of child maltreatment was measured by linkage with state child protection agency data. The two main outcomes were the prevalence and persistence of smoking at 21-year follow-up, as well as the twelve-month prevalence of nicotine use disorder for participants who completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto). RESULTS Of the 3758 young people at the 21-year follow-up, 7.5% (n=282) had a history of notified maltreatment by the age of 16 years. Of these, 167 cases were substantiated. There were 1362 (35.3%) smokers at 21-year follow-up, although only 220 (5.9%) smoked 20 plus cigarettes daily. Of the 602 participants who smoked at 14 years, 289 were still smoking seven years later. On adjusted analyses, participants who had experienced any form of notified and/or substantiated maltreatment were approximately twice as likely to be smokers at 21 years old and persistent smokers from 14 years of age. Any form of maltreatment, except sexual abuse, was also associated with an increase in the twelve-month prevalence of nicotine use disorders. CONCLUSIONS Child maltreatment is associated with both an increased onset and persistence of smoking from adolescence into young adulthood. This may have implications for smoking cessation programmes and early interventions for individual who have experienced maltreatment.
Asian Journal of Psychiatry, Jun 1, 2016
A c c e p t e d M a n u s c r i p t 4 methodological heterogeneity and to quantify the risk using... more A c c e p t e d M a n u s c r i p t 4 methodological heterogeneity and to quantify the risk using both relative and absolute measures of risk. 2. Methods This study was carried out following MOOSE guideline to ensure the quality and completeness for both systematic review and meta-analysis (Stroup et al.,2000). 2.1 Search Strategy Pertinent articles were searched using comprehensive, systematic, computerized literature searches of Pubmed (including Medline), PsycINFO, Embase, CINAHL and BIOSIS Preview databases. The search includes the period 1961 to January, 2015. We searched for articles specifically examined the association between depression and obesity for adults. To search the articles, references from the relevant literature were hand searched and used to identify additional relevant studies. We got 7760 articles and based on the information related to topic, abstract and full-text articles, a total of 7739 studies were rejected, as they clearly did not meet the inclusion criteria (see below). A total of 21 studies were finally included for this study. The search strategy is described in detail in the online appendix. 2.2 Inclusion and exclusion criteria Using the PICOS criteria (Table S1), studies were included if they 1) were published in the English language; 2) examined the prospective association between obesity and depression or vice versa; 3) contained extractable effect estimates (for depression or obesity) overall or separately by gender; 4) had a follow-up period of at least 1 year; 5) used a community or population based sample and; 6) used a standardized cutoff for BMI (overweight BMI≥25 and <30 kg/m² and Obesity≥30kg/m²) (WHO,2014) and assessed depression either clinical or using rating scales based on symptoms. Clinically diagnosed studies were identified based on
Respiratory Medicine, Mar 1, 2023
Addiction research & theory, Feb 22, 2022
Journal of Psychiatric Research, May 1, 2017
There is conflicting evidence about the contribution of maternal depression and family adversity ... more There is conflicting evidence about the contribution of maternal depression and family adversity to depression experienced by offspring. Because maternal depression and family adversity are related, there is a need to determine how they independently contribute to offspring depression. Data are from a long-running prospective birth cohort study (Mater-University of Queensland Study of Pregnancy and its outcomes-MUSP). For this study some 2200 offspring were followed up at 30 years of age. We first examine the association between maternal depression and family adversity over the period from the pregnancy to the child reaching adulthood. Then we consider the extent to which maternal depression and family adversity trajectories over this period predict CIDI/DSM-IV episodes of depression in the offspring of these mothers at 30 years of age. We find a strong bi-directional association between maternal depression and family experiences of adverse life events over the entire period the child is at home. After adjustment, children reared in a family experiencing high levels of adverse life events are more likely to experience a lifetime ever DSM-IV diagnosis of depression, are more likely to have experienced multiple episodes of lifetime ever depression, and are more likely to report their first episode of depression was at a younger age. The findings suggest the association between maternal depression and offspring depression appears to be partly attributable to the higher levels of family adversity characteristic of depressed mothers.
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Papers by Alexandra M Clavarino