Six hundred and ninety-three individuals from an area endemic for S. mansoni infection had parasi... more Six hundred and ninety-three individuals from an area endemic for S. mansoni infection had parasitological and physical examinations done. A morbidity questionnaire was also administered to each participant. Among those with S. mansoni infection, there was significant increase in watery diarrhoea, bloody diarrhoea, blood in stool and hepatomegaly. The severity of the disease appears to be directly related to the egg load and therefore these results give further justification for treatment of high intensity age groups in community based chemotherapy programmes designed to reduce morbidity in endemic areas.
Reduction in prevalence, intensity of infection and morbidity due to Schistosoma mansoni infection in a community following treatment with praziquantel
The Journal of tropical medicine and hygiene
Five hundred and twenty-three individuals from an area endemic for Schistosoma mansoni infection ... more Five hundred and twenty-three individuals from an area endemic for Schistosoma mansoni infection were followed for a 16 month period in a population-based study in rural Zambia. Those found infected in each of five surveys were treated with praziquantel (40 mg kg-1 body weight). Data on prevalence, intensity of infection and morbidity (intestinal symptoms and liver and spleen enlargements) were also gathered. At the end of the study, prevalence had fallen from 64.8% to 11.5%, intensity of infection had dropped from 28.2 to 0.5 eggs per gram of stool (geometric means) and morbidity showed marked reduction.
Serum models accurately predict liver related clinical outcomes in chronic hepatitis C
Journal of gastroenterology and hepatology, Jan 6, 2016
This study developed liver outcome scores in chronic hepatitis C (CHC) that directly predict live... more This study developed liver outcome scores in chronic hepatitis C (CHC) that directly predict liver related death, hepatocellular carcinoma (HCC) and liver decompensation. 617 CHC patients were followed for a mean of six years and randomized into a training set (n = 411) and a validation set (n = 206). Clinical outcomes were determined using a population based data-linkage system. In the training set, albumin, gamma-glutamyl transpeptidase (GGT), hyaluronic acid (HA), age and sex were in the final model to predict five year liver related death (AUROC 0.95). Two cut points (4.0, 5.5), defined three risk groups with an incidence rate for liver related death of 0.1%, 2% and 13.2% respectively (p < 0.001). Albumin, GGT, HA, age and sex were used to predict five year liver decompensation (AUROC 0.90). A cut point of 4.5 gave a sensitivity of 94% and a specificity of 84% to predict five year decompensation and defined two groups with an incidence rate for decompensation of 0.2% and 5.8%...
This paper describes the results of an online survey that examined commuting patterns, potential ... more This paper describes the results of an online survey that examined commuting patterns, potential for change and barriers and motivators affecting transport decisions in a University population (nZ1040 students, nZ1170 staff). Overall, 21.5% of staff and 46.8% of students at The University of Western Australia regularly used active modes, and potentially an additional 30% of staff and students would switch to active modes. The results suggested that reducing barriers to using active modes, in particular reducing actual and perceived travel time by bus and bicycle would have the greatest impact on commuting patterns. Some policy applications appeared to hold particular promise, including an implementation of a subsidised public transport pass (U-Pass), increased student housing on or near campus, increased cost of parking, and improved bus services and cycle networks. q
Oral Abstracts S41 ness and IR has not been explored in PCOS. We have compared IR pre and post in... more Oral Abstracts S41 ness and IR has not been explored in PCOS. We have compared IR pre and post intensified exercise, using the gold standard insulin clamp technique and explored relationships with fitness, in overweight women with PCOS and weight matched non-PCOS controls.
Background. The RESIDential Environment project (RESIDE) is a longitudinal study evaluating the i... more Background. The RESIDential Environment project (RESIDE) is a longitudinal study evaluating the impact of a new residential design code on walking.
Early Life Events and Motor Development in Childhood and Adolescence: A Longitudinal Study
Acta Paediatrica, 2015
Few studies have reported on early life risk factors for motor development outcomes past childhoo... more Few studies have reported on early life risk factors for motor development outcomes past childhood. Antenatal, perinatal and neonatal factors affecting motor development from late childhood to adolescence were explored. As sex differences in motor development have been previously reported males and females were examined separately. Participants (N = 2868) were from the Western Australian Pregnancy Cohort Study. Obstetric and neonatal data were examined to determine factors related to motor development at 10 (n = 1622), 14 (n = 1584) and 17 (n = 1221) years. The Neuromuscular Development Index (NDI) of the McCarron Assessment of Motor Development determined offspring motor proficiency. Linear Mixed Models were developed to allow for changes in motor development over time. Maternal preeclampsia, caesarean section and low income were negatively related to male and female motor outcomes. Lower percentage of optimal birth weight was related to a lower male NDI. Younger maternal age, smoking during early pregnancy and stress during later pregnancy were related to lower female NDIs. Events experienced during pregnancy were related to motor development into late adolescence. Males and females were influenced differently by antenatal and perinatal risk factors; this may be due to sex specific developmental pathways. This article is protected by copyright. All rights reserved.
Cumulative Illness Rating Scale to estimate multi-morbidity in primary care
ABSTRACT The progressive ageing of the Australian population will inevitably lead to increasing m... more ABSTRACT The progressive ageing of the Australian population will inevitably lead to increasing multi-morbidity and increasing demands on the health care system. Increased survival times as well as declining disability cause health care needs and health care costs to rise in tandem. Demands on primary care services will be more acute in areas with higher numbers of aged patients.
Prevalence of sexual dysfunction after risk-reducing salpingo-oophorectomy
Gynecologic Oncology, 2015
To determine the prevalence of sexual dysfunction in women after risk-reducing salpingo-oophorect... more To determine the prevalence of sexual dysfunction in women after risk-reducing salpingo-oophorectomy (RRSO) and to assess factors which may influence sexual wellbeing following this procedure. This work is a cross-sectional study of women who underwent RRSO at a tertiary gynecologic oncology unit between January 2009 and October 2014. Data collection involved a comprehensive questionnaire including validated measures of sexual function, sexual distress, relationship satisfaction, body image, impact of event, menopause specific quality of life, and general quality of life. Participants were invited to undergo blood testing for serum testosterone and free androgen index (FAI). 119 of the 206 eligible women participated (58%), with a mean age of 52years. The prevalence of female sexual dysfunction (FSD) was 74% and the prevalence of hypoactive sexual desire disorder (HSDD) was 73%. Common sexual issues experienced included; lubrication difficulty (44%), reduced sexual satisfaction (41%), dyspareunia (28%) and orgasm difficulty (25%). Relationship satisfaction, the use of topical vaginal estrogen and lower generalized body pain were significantly associated with a decreased likelihood of sexual dysfunction. Serum testosterone, FAI, the use of systemic hormone replacement therapy (HRT), prior history of breast cancer, menopausal status at the time of surgery and hysterectomy did not correlate with sexual dysfunction. The prevalence of FSD and HSDD after RRSO was 74% and 73% respectively. Relationship satisfaction, low bodily pain and use of topical vaginal estrogen were associated with a lower likelihood of sexual dysfunction. There was no correlation between serum testosterone or FAI, and sexual dysfunction.
The Impact of Maternal Gestational Stress on Motor Development in Late Childhood and Adolescence: A Longitudinal Study
Child development, Jan 14, 2015
The number and timing of stressors experienced during pregnancy were investigated using longitudi... more The number and timing of stressors experienced during pregnancy were investigated using longitudinal data from the Western Australian Pregnancy (Raine) Study cohort (N = 2,900). Motor development data were collected at 10 (n = 1,622), 14 (n = 1,584), and 17 (n = 1,222) years using the McCarron Assessment of Neuromuscular Development. Linear mixed models were used to examine the effect of stress on motor development, accounting for repeated measures. Number of stressful events and mean Neuromuscular Development Index were negatively related (β = -1.197, p = .001). Stressful events experienced in late pregnancy were negatively related with offspring motor development (β = -0.0541, p = .050), while earlier stressful events had no significant impact.
Does Motor Competence in Childhood Protect Against Adolescent Obesity?
A dynamic and developmental relationship between physical activity, fitness, motor competence, an... more A dynamic and developmental relationship between physical activity, fitness, motor competence, and obesity is considered, but not always empirically shown in children and adolescents. We present data from the Western Australian Pregnancy Cohort (Raine) Study to demonstrate a relationship between childhood motor competence and adolescent obesity. Data from 1,403 participants (674 females and 729 males) was available for analysis over eight time points from birth to age 14 years. Cross-sectional (ANOVA, Chi-square), longitudinal (linear mixed model), and interrelationship modelling (SEM) analysis was used. Abnormal motor development (Denver II) and delayed milestone achievement (Infant Monitoring Questionnaire) at ages 1-3 years; below average attainment of parent perceived motor skills at age 10 years; and lower motor competence scores (McCarron Assessment of Neuromuscular Development) were associated with obesity at age 14 years. Interrelationship modelling at ages 10 and 14 years, ...
A mismatch between the brain's motor control and sensory systems has been suggested as one me... more A mismatch between the brain's motor control and sensory systems has been suggested as one mechanism whereby maladaptive neuroplastic changes contribute to the experience of chronic pain. Several studies have investigated this hypothesis by artificially inducing a state of sensory-motor incongruence using mirrors. The data to date appear to suggest that creating an environment of sensori-motor incongruence induces various sensory
Cumulative Illness Rating Scale to estimate multi-morbidity in primary care
The progressive ageing of the Australian population will inevitably lead to increasing multi-morb... more The progressive ageing of the Australian population will inevitably lead to increasing multi-morbidity and increasing demands on the health care system. Increased survival times as well as declining disability cause health care needs and health care costs to rise in tandem. Demands on primary care services will be more acute in areas with higher numbers of aged patients.
Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current inter... more Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current interventions are only moderately successful [1]. There is growing evidence of extensive cortical reorganisation and perceptual disturbances which may contribute to the condition [2]. The aim of this study was to test whether a graded sensorimotor retraining program, aimed at influencing cortical representation, would reduce pain
This study examined the influence of type and duration of infant feeding on adiposity rebound and... more This study examined the influence of type and duration of infant feeding on adiposity rebound and the tracking of body mass index (BMI) from birth to 14 years of age. A sample of 1330 individuals over eight follows-ups was drawn from the Western Australian Pregnancy Cohort (Raine) Study. Trajectories of BMI from birth to adolescence using linear mixed model analysis investigated the influence of age at which breastfeeding was stopped and the age at which other milk was introduced (binomial 4-month cutoff point). A subsample of linear mixed model-predicted BMI was used to determine BMI and age at nadir for early infant feeding groups. Chi-square analysis between early feeding and weight status (normal weight, overweight and obese) groups found a significant difference between thee age at which breastfeeding was stopped (P<0.001) and the age at which other milk was introduced (P=0.011), with a higher proportion of overweight and obese in the < or = 4-month group, even after cont...
This study examined the possible inter-changeability of common proxy measures of adiposity in ado... more This study examined the possible inter-changeability of common proxy measures of adiposity in adolescent 14 year olds from a large cohort. A sample of 1,607 adolescents (n = 825 male and n = 782 female) was drawn from the Western Australian Pregnancy Cohort (Raine) Study. Pearson Product Moment Correlation, Bland-Altman method, and Bland regression were used to determine the level of agreement between common proxy adiposity measures. The Bland-Altman and Bland regression results supported the notion that the two indices (Waist-height-Ratio and Body-Mass-Index) are measuring 33 a similar construct (F = .974, p = .324). However 95 percent limits of agreement differed between the methods (95% CI [21.04, 21.52] and [17.71, 24.90] respectively), with the Bland regression approach suggesting that the measures are not interchangeable. These results provide evidence that different adiposity measures are not comparable, particularly when tracking weight status over time. The validity of WHR as an adiposity measure is questioned, and the similarity in weight status groupings based on WHtR and BMI, indicate these measures are most comparable.
Six hundred and ninety-three individuals from an area endemic for S. mansoni infection had parasi... more Six hundred and ninety-three individuals from an area endemic for S. mansoni infection had parasitological and physical examinations done. A morbidity questionnaire was also administered to each participant. Among those with S. mansoni infection, there was significant increase in watery diarrhoea, bloody diarrhoea, blood in stool and hepatomegaly. The severity of the disease appears to be directly related to the egg load and therefore these results give further justification for treatment of high intensity age groups in community based chemotherapy programmes designed to reduce morbidity in endemic areas.
Reduction in prevalence, intensity of infection and morbidity due to Schistosoma mansoni infection in a community following treatment with praziquantel
The Journal of tropical medicine and hygiene
Five hundred and twenty-three individuals from an area endemic for Schistosoma mansoni infection ... more Five hundred and twenty-three individuals from an area endemic for Schistosoma mansoni infection were followed for a 16 month period in a population-based study in rural Zambia. Those found infected in each of five surveys were treated with praziquantel (40 mg kg-1 body weight). Data on prevalence, intensity of infection and morbidity (intestinal symptoms and liver and spleen enlargements) were also gathered. At the end of the study, prevalence had fallen from 64.8% to 11.5%, intensity of infection had dropped from 28.2 to 0.5 eggs per gram of stool (geometric means) and morbidity showed marked reduction.
Serum models accurately predict liver related clinical outcomes in chronic hepatitis C
Journal of gastroenterology and hepatology, Jan 6, 2016
This study developed liver outcome scores in chronic hepatitis C (CHC) that directly predict live... more This study developed liver outcome scores in chronic hepatitis C (CHC) that directly predict liver related death, hepatocellular carcinoma (HCC) and liver decompensation. 617 CHC patients were followed for a mean of six years and randomized into a training set (n = 411) and a validation set (n = 206). Clinical outcomes were determined using a population based data-linkage system. In the training set, albumin, gamma-glutamyl transpeptidase (GGT), hyaluronic acid (HA), age and sex were in the final model to predict five year liver related death (AUROC 0.95). Two cut points (4.0, 5.5), defined three risk groups with an incidence rate for liver related death of 0.1%, 2% and 13.2% respectively (p < 0.001). Albumin, GGT, HA, age and sex were used to predict five year liver decompensation (AUROC 0.90). A cut point of 4.5 gave a sensitivity of 94% and a specificity of 84% to predict five year decompensation and defined two groups with an incidence rate for decompensation of 0.2% and 5.8%...
This paper describes the results of an online survey that examined commuting patterns, potential ... more This paper describes the results of an online survey that examined commuting patterns, potential for change and barriers and motivators affecting transport decisions in a University population (nZ1040 students, nZ1170 staff). Overall, 21.5% of staff and 46.8% of students at The University of Western Australia regularly used active modes, and potentially an additional 30% of staff and students would switch to active modes. The results suggested that reducing barriers to using active modes, in particular reducing actual and perceived travel time by bus and bicycle would have the greatest impact on commuting patterns. Some policy applications appeared to hold particular promise, including an implementation of a subsidised public transport pass (U-Pass), increased student housing on or near campus, increased cost of parking, and improved bus services and cycle networks. q
Oral Abstracts S41 ness and IR has not been explored in PCOS. We have compared IR pre and post in... more Oral Abstracts S41 ness and IR has not been explored in PCOS. We have compared IR pre and post intensified exercise, using the gold standard insulin clamp technique and explored relationships with fitness, in overweight women with PCOS and weight matched non-PCOS controls.
Background. The RESIDential Environment project (RESIDE) is a longitudinal study evaluating the i... more Background. The RESIDential Environment project (RESIDE) is a longitudinal study evaluating the impact of a new residential design code on walking.
Early Life Events and Motor Development in Childhood and Adolescence: A Longitudinal Study
Acta Paediatrica, 2015
Few studies have reported on early life risk factors for motor development outcomes past childhoo... more Few studies have reported on early life risk factors for motor development outcomes past childhood. Antenatal, perinatal and neonatal factors affecting motor development from late childhood to adolescence were explored. As sex differences in motor development have been previously reported males and females were examined separately. Participants (N = 2868) were from the Western Australian Pregnancy Cohort Study. Obstetric and neonatal data were examined to determine factors related to motor development at 10 (n = 1622), 14 (n = 1584) and 17 (n = 1221) years. The Neuromuscular Development Index (NDI) of the McCarron Assessment of Motor Development determined offspring motor proficiency. Linear Mixed Models were developed to allow for changes in motor development over time. Maternal preeclampsia, caesarean section and low income were negatively related to male and female motor outcomes. Lower percentage of optimal birth weight was related to a lower male NDI. Younger maternal age, smoking during early pregnancy and stress during later pregnancy were related to lower female NDIs. Events experienced during pregnancy were related to motor development into late adolescence. Males and females were influenced differently by antenatal and perinatal risk factors; this may be due to sex specific developmental pathways. This article is protected by copyright. All rights reserved.
Cumulative Illness Rating Scale to estimate multi-morbidity in primary care
ABSTRACT The progressive ageing of the Australian population will inevitably lead to increasing m... more ABSTRACT The progressive ageing of the Australian population will inevitably lead to increasing multi-morbidity and increasing demands on the health care system. Increased survival times as well as declining disability cause health care needs and health care costs to rise in tandem. Demands on primary care services will be more acute in areas with higher numbers of aged patients.
Prevalence of sexual dysfunction after risk-reducing salpingo-oophorectomy
Gynecologic Oncology, 2015
To determine the prevalence of sexual dysfunction in women after risk-reducing salpingo-oophorect... more To determine the prevalence of sexual dysfunction in women after risk-reducing salpingo-oophorectomy (RRSO) and to assess factors which may influence sexual wellbeing following this procedure. This work is a cross-sectional study of women who underwent RRSO at a tertiary gynecologic oncology unit between January 2009 and October 2014. Data collection involved a comprehensive questionnaire including validated measures of sexual function, sexual distress, relationship satisfaction, body image, impact of event, menopause specific quality of life, and general quality of life. Participants were invited to undergo blood testing for serum testosterone and free androgen index (FAI). 119 of the 206 eligible women participated (58%), with a mean age of 52years. The prevalence of female sexual dysfunction (FSD) was 74% and the prevalence of hypoactive sexual desire disorder (HSDD) was 73%. Common sexual issues experienced included; lubrication difficulty (44%), reduced sexual satisfaction (41%), dyspareunia (28%) and orgasm difficulty (25%). Relationship satisfaction, the use of topical vaginal estrogen and lower generalized body pain were significantly associated with a decreased likelihood of sexual dysfunction. Serum testosterone, FAI, the use of systemic hormone replacement therapy (HRT), prior history of breast cancer, menopausal status at the time of surgery and hysterectomy did not correlate with sexual dysfunction. The prevalence of FSD and HSDD after RRSO was 74% and 73% respectively. Relationship satisfaction, low bodily pain and use of topical vaginal estrogen were associated with a lower likelihood of sexual dysfunction. There was no correlation between serum testosterone or FAI, and sexual dysfunction.
The Impact of Maternal Gestational Stress on Motor Development in Late Childhood and Adolescence: A Longitudinal Study
Child development, Jan 14, 2015
The number and timing of stressors experienced during pregnancy were investigated using longitudi... more The number and timing of stressors experienced during pregnancy were investigated using longitudinal data from the Western Australian Pregnancy (Raine) Study cohort (N = 2,900). Motor development data were collected at 10 (n = 1,622), 14 (n = 1,584), and 17 (n = 1,222) years using the McCarron Assessment of Neuromuscular Development. Linear mixed models were used to examine the effect of stress on motor development, accounting for repeated measures. Number of stressful events and mean Neuromuscular Development Index were negatively related (β = -1.197, p = .001). Stressful events experienced in late pregnancy were negatively related with offspring motor development (β = -0.0541, p = .050), while earlier stressful events had no significant impact.
Does Motor Competence in Childhood Protect Against Adolescent Obesity?
A dynamic and developmental relationship between physical activity, fitness, motor competence, an... more A dynamic and developmental relationship between physical activity, fitness, motor competence, and obesity is considered, but not always empirically shown in children and adolescents. We present data from the Western Australian Pregnancy Cohort (Raine) Study to demonstrate a relationship between childhood motor competence and adolescent obesity. Data from 1,403 participants (674 females and 729 males) was available for analysis over eight time points from birth to age 14 years. Cross-sectional (ANOVA, Chi-square), longitudinal (linear mixed model), and interrelationship modelling (SEM) analysis was used. Abnormal motor development (Denver II) and delayed milestone achievement (Infant Monitoring Questionnaire) at ages 1-3 years; below average attainment of parent perceived motor skills at age 10 years; and lower motor competence scores (McCarron Assessment of Neuromuscular Development) were associated with obesity at age 14 years. Interrelationship modelling at ages 10 and 14 years, ...
A mismatch between the brain's motor control and sensory systems has been suggested as one me... more A mismatch between the brain's motor control and sensory systems has been suggested as one mechanism whereby maladaptive neuroplastic changes contribute to the experience of chronic pain. Several studies have investigated this hypothesis by artificially inducing a state of sensory-motor incongruence using mirrors. The data to date appear to suggest that creating an environment of sensori-motor incongruence induces various sensory
Cumulative Illness Rating Scale to estimate multi-morbidity in primary care
The progressive ageing of the Australian population will inevitably lead to increasing multi-morb... more The progressive ageing of the Australian population will inevitably lead to increasing multi-morbidity and increasing demands on the health care system. Increased survival times as well as declining disability cause health care needs and health care costs to rise in tandem. Demands on primary care services will be more acute in areas with higher numbers of aged patients.
Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current inter... more Chronic nonspecific low back pain (CNSLBP) is a common healthcare problem for which current interventions are only moderately successful [1]. There is growing evidence of extensive cortical reorganisation and perceptual disturbances which may contribute to the condition [2]. The aim of this study was to test whether a graded sensorimotor retraining program, aimed at influencing cortical representation, would reduce pain
This study examined the influence of type and duration of infant feeding on adiposity rebound and... more This study examined the influence of type and duration of infant feeding on adiposity rebound and the tracking of body mass index (BMI) from birth to 14 years of age. A sample of 1330 individuals over eight follows-ups was drawn from the Western Australian Pregnancy Cohort (Raine) Study. Trajectories of BMI from birth to adolescence using linear mixed model analysis investigated the influence of age at which breastfeeding was stopped and the age at which other milk was introduced (binomial 4-month cutoff point). A subsample of linear mixed model-predicted BMI was used to determine BMI and age at nadir for early infant feeding groups. Chi-square analysis between early feeding and weight status (normal weight, overweight and obese) groups found a significant difference between thee age at which breastfeeding was stopped (P<0.001) and the age at which other milk was introduced (P=0.011), with a higher proportion of overweight and obese in the < or = 4-month group, even after cont...
This study examined the possible inter-changeability of common proxy measures of adiposity in ado... more This study examined the possible inter-changeability of common proxy measures of adiposity in adolescent 14 year olds from a large cohort. A sample of 1,607 adolescents (n = 825 male and n = 782 female) was drawn from the Western Australian Pregnancy Cohort (Raine) Study. Pearson Product Moment Correlation, Bland-Altman method, and Bland regression were used to determine the level of agreement between common proxy adiposity measures. The Bland-Altman and Bland regression results supported the notion that the two indices (Waist-height-Ratio and Body-Mass-Index) are measuring 33 a similar construct (F = .974, p = .324). However 95 percent limits of agreement differed between the methods (95% CI [21.04, 21.52] and [17.71, 24.90] respectively), with the Bland regression approach suggesting that the measures are not interchangeable. These results provide evidence that different adiposity measures are not comparable, particularly when tracking weight status over time. The validity of WHR as an adiposity measure is questioned, and the similarity in weight status groupings based on WHtR and BMI, indicate these measures are most comparable.
Uploads
Papers by Max Bulsara