Catherine D’Este

Seasonal variation in stroke in the Hunter Region, Australia: a 5-year hospital-based study, 1995-2000

Background and Purpose— Seasonal variation in stroke has long been recognized. To date, there are minimal published data on seasonal variations in rates of stroke and subsequent case fatality in the Southern Hemisphere. The aim of this study was to examine stroke seasonality through the use of data from a hospital-based stroke register in the Hunter Region of New South Wales, Australia. Methods— From July 1, 1995, to June 30, 2000, 3803 stroke events were registered in residents of the Hunter Region, New South Wales, Australia. We analyzed the trend of seasonal and monthly stroke attack rates and case-fatality rates using Poisson regressions with age and sex as covariates. Results— Stroke attack rates were highest in the winter and lowest in the summer. From February (summer) to July (winter), there was a significant trend in increasing stroke attack rates (rate ratio, 1.07; 95% confidence interval, 1.05 to 1.10;P <0.001). This increase was seen mainly in those ≥65 years of age. Case-fatality rates showed similar trends with a 1- to 2-month lag compared with attack rates. Conclusions— There is an increase in stroke attack rates and case-fatality rate from summer to winter in the Hunter Region, Australia. These trends are similar to those found in the Northern Hemisphere.

Prevalence and correlates of cancer survivors’ supportive care needs 6 months after diagnosis: a population-based cross-sectional study

BackgroundAn understanding of the nature and magnitude of the impact of cancer is critical to planning how best to deliver supportive care to the growing population of cancer survivors whose need for care may span many years. This study aimed to describe the prevalence of and factors associated with moderate to high level unmet supportive care needs among adult cancer survivors six months after diagnosis.MethodsA population-based sample of adult cancer survivors diagnosed with one of the eight most incident cancers in Australia was recruited from two state-based cancer registries. Data for 1323 survivors were obtained by self-report questionnaire and linkage with cancer registry data. Unmet needs were assessed by the 34-item Supportive Care Needs Survey (SCNS-SF34). The data were examined using chi-square and multiple logistic regression analyses.ResultsA total of 444 (37%) survivors reported at least one ‘moderate to high’ level unmet need and 496 (42%) reported ‘no need’ for help. Moderate to high level unmet needs were most commonly reported in the psychological (25%) and physical aspects of daily living (20%) domains. The five most frequently endorsed items of moderate to high unmet need were concerns about the worries of those close to them (15%), fears about the cancer spreading (14%), not being able to do the things they used to do (13%), uncertainty about the future (13%) and lack of energy/tiredness (12%). Survivors’ psychological characteristics were the strongest indicators of unmet need, particularly caseness for anxious preoccupation coping which was associated (OR = 2.2-5.9) with unmet need for help across all domains.ConclusionsUnmet supportive care needs are prevalent among a subgroup of survivors transitioning from active treatment to survivorship, although lower than previously reported. In addition to coping support, valuable insight about how to prevent or address survivors’ unmet needs could be gained by examining the substantial proportion of survivors who report no unmet needs.

Haplotype analysis of VDR gene polymorphisms: a meta-analysis

Introduction: Although many studies have addressed the relationship between multiple individual polymorphisms in the vitamin D receptor (VDR) gene and bone health, few have analyzed this data in terms of haplotypes. We performed a meta-analysis of studies with data on the BsmI, ApaI, and TaqI polymorphisms in order to (a) estimate haplotype frequencies, (b) determine linkage disequilibrium (LD), and (c) estimate the magnitude of the association between haplotypes and osteoporosis/bone mineral density (BMD). Methods: Haplotypes were inferred using the expectation-maximization algorithm (EM); log-linear models were used to determine association with osteoporosis; and regression analysis with variance components was used to determine association with BMD. Results: Our results indicate that the most common haplotype for the VDR gene, regardless of ethnicity, is baT, followed by BAt and bAT in Caucasians, and bAT and BaT in Asians. This indicates strong LD between the BsmI and TaqI polymorphisms. We demonstrate a gain in power when considering the haplotypes rather than the individual polymorphisms separately, i.e., although BsmI, ApaI, and TaqI were not significantly associated with osteoporosis on their own, the haplotypes Bat and BAt were significantly associated, with an OR of approximately 4. Conclusion: We have applied haplotype analysis to the VDR polymorphisms and bone measures. We also highlight a number of methodologic issues, including linkage disequilibrium, the robustness of the EM algorithm in this context, and the potential for exploring effect modification.

Association between type 2 diabetes and chronic arsenic exposure in drinking water: A cross sectional study in Bangladesh

BackgroundChronic exposure to high level of inorganic arsenic in drinking water has been associated with Type 2 Diabetes (T2D). Most research has been ecological in nature and has focused on high levels of arsenic exposure with few studies directly measuring arsenic levels in drinking water as an index of arsenic exposure. The effect of low to moderate levels of arsenic exposure on diabetes risk is largely unknown thus our study is adding further knowledge over previous works.MethodsThis cross sectional study was conducted in 1004 consenting women and men from 1682 eligible participants yielding a participation rate of 60%. These participants are aged > 30 years and were living in Bangladesh and had continuously consumed arsenic-contaminated drinking water for at least 6 months. T2D cases were diagnosed using glucometer following the new diagnostic criteria (Fasting Blood Glucose > 126 mg/dl) from the WHO guideline (WHO 2006), or a self-reported physician diagnosis of type 2 diabetes. Association between T2D and chronic arsenic exposure was estimated by multiple logistic regression with adjustment for age, sex, education, Body Mass Index (BMI) and family history of T2D.ResultsA total of 1004 individuals participated in the study. The prevalence of T2D was 9% (95% CI 7-11%). After adjustment for diabetes risk factors, an increased risk of type 2 diabetes was observed for arsenic exposure over 50 μg/L with those in the highest category having almost double the risk of type 2 diabetes (OR=1.9 ; 95% CI 1.1-3.5). For most levels of arsenic exposure, the risk estimates are higher with longer exposure; a dose–response pattern was also observed.ConclusionsThese findings suggest an association between chronic arsenic exposure through drinking water and T2D. Risks are generally higher with longer duration of arsenic exposure. The risk of T2D is highest among those who were exposed to the highest concentration of arsenic for more than 10 years.

Prevalence and Magnitude of Classical Risk Factors for Stroke in a Cohort of 5092 Chinese Steelworkers Over 13.5 Years of Follow-up

Background and Purpose— Stroke is the most common manifestation of cardiovascular disease (CVD) among Chinese men. This study addresses the prevalence and magnitude of classic CVD risk factors associated with total, ischemic, and hemorrhagic stroke in a Chinese cohort of at-risk men, compared with white populations. We also address which blood pressure index: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) is the best predictor of stroke. Methods— A cohort of 5092 male steelworkers (aged 18 to 74 years) recruited between 1974 to 1980 was followed up for an average of 13.5 years. The results showed that the risk ratios (RRs) of stroke associated with classic risk factors in this Asian population were not different than in whites, except for blood pressure. The RRs of total stroke for each 10mm Hg rise in SBP and DBP in this Asian group (1.4 and 1.8, respectively) were higher than in whites (1.2 to 1.3 and 1.2 to 1.5, respectively). The population attributable risk (PAR) for hypertension (160/95 mm Hg cutoff) to stroke was higher in Asians (ie, 31% for ischemic and 42% for hemorrhagic stroke) than in whites (25% and 34%, respectively). Conclusion— Our results indicate that hypertension is a greater risk factor for stroke in Asians than whites, especial for hemorrhagic stroke. The most predictive blood pressure (BP) index for stroke is MAP. However, the prevalence or magnitude of these traditional risk factors appears unlikely to explain the differing spectrum of CVD among Asians.

Comparison of the Tono-Pen and Goldmann tonometer for measuring intraocular pressure in patients with glaucoma.

Aim: To estimate agreement between measurement of intraocular pressure (IOP) by the Tono‐Pen and by the Goldmann tonometer. The hypothesis tested was that the mean difference in measurements would be <–2 mmHg.

A population-based cross-sectional study of colorectal cancer screening practices of first-degree relatives of colorectal cancer patients

BackgroundThe aim of this study was to determine the proportions and predictors of first-degree relatives (FDRs) of colorectal cancer (CRC) patients (i) ever receiving any CRC testing and (ii) receiving CRC screening in accordance with CRC screening guidelines.MethodsColorectal cancer patients and their FDRs were recruited through the population-based Victorian Cancer Registry, Victoria, Australia. Seven hundred and seven FDRs completed telephone interviews. Of these, 405 FDRs were deemed asymptomatic and eligible for analysis.ResultsSixty-nine percent of FDRs had ever received any CRC testing. First-degree relatives of older age, those with private health insurance, siblings and FDRs who had ever been asked about family history of CRC by a doctor were significantly more likely than their counterparts to have ever received CRC testing. Twenty-five percent of FDRs “at or slightly above average risk” were adherent to CRC screening guidelines. For this group, adherence to guideline-recommended screening was significantly more likely to occur for male FDRs and those with a higher level of education. For persons at “moderately increased risk” and “potentially high risk”, 47% and 49% respectively adhered to CRC screening guidelines. For this group, guideline-recommended screening was significantly more likely to occur for FDRs who were living in metropolitan areas, siblings, those married or partnered and those ever asked about family history of CRC.ConclusionsA significant level of non-compliance with screening guidelines was evident among FDRs. Improved CRC screening in accordance with guidelines and effective systematic interventions to increase screening rates among population groups experiencing inequality are needed.Trial RegistrationAustralian and New Zealand Clinical Trial Registry: ACTRN12609000628246

Knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS).

OBJECTIVE To assess knowledge, satisfaction with information, decisional conflict and psychological morbidity amongst women diagnosed with ductal carcinoma in situ (DCIS) and to explore the factors associated with less knowledge and greater confusion about DCIS. METHODS A cross-sectional survey of women diagnosed with DCIS in Australia (N=144). RESULTS This study found misunderstanding and confusion amongst women diagnosed with DCIS and a desire for more information about their breast disease. Approximately half of participants worried about their breast disease metastasizing; approximately half expressed high decisional conflict; 12% were anxious and 2% were depressed. Logistic regression analysis demonstrated that worry about dying from the breast disease was significantly associated with not knowing that DCIS could not metastasize (OR 3.9; 95% CI 1.03-14.25); and confusion about whether DCIS could metastasize was significantly associated with dissatisfaction with information (OR 12.5; 95% CI 3.8-40.2). CONCLUSION Good communication about how DCIS differs from invasive breast cancer is essential to alleviating the confusion and worry amongst women with DCIS. PRACTICE IMPLICATIONS Recommendations about how best to communicate a diagnosis of DCIS, including the uncertainties, are needed to guide health professionals to promote better understanding about DCIS and increase the well-being of women with DCIS.

The reliability and validity of a short FFQ among Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children

OBJECTIVE To determine the reproducibility and validity of a short FFQ (SFFQ) for Australian rural children aged 10 to 12 years, particularly Aboriginal and Torres Strait Islander children. DESIGN In this cross-sectional study participants completed the SFFQ on two occasions and three 24 h recalls. Concurrent validity was established by comparing results of the first SFFQ against food recalls; reproducibility was established by comparing the two SFFQ. SETTING The north coast of New South Wales in the Australian summer of late 2005. SUBJECTS Two hundred and forty-one children (ninety-two Aboriginal and Torres Strait Islander children and 100 boys) completed two SFFQ and were included in the reproducibility study; of these, 205 participants with a mean age of 10·8 (sd 0·7) years took part in the validity study. RESULTS The SFFQ showed moderate to good reproducibility among all children with kappa coefficients for repeated measures between 0·41 and 0·80. Eighteen of twenty-three questions demonstrated good validity against the mean of the 24 h recalls, with statistically significant increasing trends (P ≤ 0·05) for mean daily weight and/or frequency as survey response categories increased. A similar number of short questions showed good validity for Aboriginal and Torres Strait Islander children as for their non-Indigenous counterparts. CONCLUSIONS Many short questions in this SFFQ are able to discriminate between different categories of food intake and provide information on relative intake within the given population. They can be used to monitor and/or evaluate population-wide health programmes, including those with rural Aboriginal and Torres Strait Islander children.

A cross-sectional study assessing the self-reported weight loss strategies used by adult Australian general practice patients

BackgroundObesity is a significant public health concern. General practitioners (GPs) see a large percentage of the population and are well placed to provide weight management advice. There has been little examination of the types of weight loss strategies used in Australian general practice patients. This cross-sectional study aimed to describe the proportion of normal weight, overweight and obese general practice patients who report trying to lose weight in the past 12 months, the types of weight loss strategies and diets used as well as the proportion consulting their GP prior to trying to lose weight.MethodsAdult patients completed a touchscreen computer survey while waiting for their appointment. Responses from 1335 patients in twelve Australian practices are reported.ResultsA larger proportion of obese patients had tried to lose weight in the past 12 months (73%) compared to those who were overweight (55%) and normal weight (33%). The most commonly used strategy used was changing diet and increasing exercise in all BMI categories. Less than 10% used strategies such as prescription medication, over the counter supplements and consulted a weight loss specialist. Low calorie and low fat diets were the most frequently reported diets used to lose weight in those who were normal weight, overweight and obese. Overall, the proportion seeking GP advice was low, with 12% of normal weight, 15% of overweight and 43% of obese patients consulting their GP prior to trying to lose weight.ConclusionsA large proportion of overweight or obese patients have tried to lose weight and utilized strategies such as changing diet and increasing exercise. Most attempts however were unassisted, with low rates of consultation with GPs and weight loss specialists. Ways to assist overweight and obese general practice patients with their weight loss attempts need to be identified.