Ingrid Flight

Metformin in polycystic ovary syndrome: systematic review and meta-analysis

Abstract Objective To assess the effectiveness of metformin in improving clinical and biochemical features of polycystic ovary syndrome. Design Systematic review and meta-analysis. Data sources Randomised controlled trials that investigated the effect of metformin compared with either placebo or no treatment, or compared with an ovulation induction agent. Selection of studies 13 trials were included for analysis, including 543 women with polycystic ovary syndrome that was defined by using biochemical or ultrasound evidence. Main outcome measure Pregnancy and ovulation rates. Secondary outcomes of clinical and biochemical features of polycystic ovary syndrome. Results Meta-analysis showed that metformin is effective in achieving ovulation in women with polycystic ovary syndrome, with odds ratios of 3.88 (95% confidence interval 2.25 to 6.69) for metformin compared with placebo and 4.41 (2.37 to 8.22) for metformin and clomifene compared with clomifene alone. An analysis of pregnancy rates shows a significant treatment effect for metformin and clomifene (odds ratio 4.40, 1.96 to 9.85). Metformin has an effect in reducing fasting insulin concentrations, blood pressure, and low density lipoprotein cholesterol. We found no evidence of any effect on body mass index or waist:hip ratio. Metformin was associated with a higher incidence of nausea, vomiting, and other gastrointestinal disturbance. Conclusions Metformin is an effective treatment for anovulation in women with polycystic ovary syndrome. Its choice as a first line agent seems justified, and there is some evidence of benefit on variables of the metabolic syndrome. No data are available regarding the safety of metformin in long term use in young women and only limited data on its safety in early pregnancy. It should be used as an adjuvant to general lifestyle improvements and not as a replacement for increased exercise and improved diet.

Rising incidence of early‐onset colorectal cancer in Australia over two decades: Report and review

The average age at diagnosis for colorectal cancer (CRC) in Australia is 69, and the age‐specific incidence rises rapidly after age 50 years. The incidence has stabilized or is declining in older age groups in Australia during recent decades, possibly related to the increased uptake of screening and high‐risk surveillance. In the same time frame, a rising incidence of CRC in younger adults has been well‐documented in the United States. This rise in incidence in the young has not been reported from other countries that share long‐term exposure to westernised urban lifestyles. Using data from the Australian Institute of Health and Welfare, we examined trends in national incidence rates for CRC under age 50 years and observed that rates in people under age 40 years have been rising for the last two decades. We further performed a review of the literature regarding CRC in young adults to outline the extent of current understanding, explore potential risk factors such as obesity, alcohol, and sedentary lifestyles, and to identify the questions remaining to be addressed. Although absolute numbers might not justify a population screening approach, the dispersal of young adults with CRC across the primary health‐care system decreases probability of their recognition. Patient and physician awareness, aided by stool and emerging blood‐screening tests and risk profiling tools, have the potential to aid in identification of those young adults who would most benefit from a colonoscopy through early detection of CRCs or by removal of advanced polyps.

Internet usage and openness to internet-delivered health information among Australian adults aged over 50 years

BACKGROUND The cost of healthcare in Australias ageing population is ever increasing. In an attempt to reduce these rising costs, the internet has been suggested as a possible means of disseminating health-related information and promoting preventive health behaviours. OBJECTIVE Our objective was to determine the proportion of Australians aged 50-74 years who have internet access, and the characteristics of internet usage, current online health information seeking behaviour, and the willingness to receive unsolicited health information via the Internet. METHOD A random sample of N=25,511 urban older Australians aged 50 to 74 years received a questionnaire via mail and were asked to complete questions concerning variables related to internet usage. N=8,762 returned a competed questionnaire. RESULTS Eighty-two per cent of respondents reported having internet access, mainly at home (94%), and the majority actively use this technology (93%). Younger people and those of higher socio-economic status and higher education were more likely to have access (p<.001). Approximately 61% reported actively seeking health-related information online but only 32% expressed a willingness to receive unsolicited health information via the internet. Females were more likely to currently search for health-related information than males but were less likely to be open to receiving unsolicited health information (both p<.001). CONCLUSION According to the data it appears the majority of urban Australians aged over 50 have access to the internet at some location and 60% of them use the internet for health-related purposes. The data also suggests, however, that delivering health information via the internet alone would disadvantage those who are older, less educated, and less financially well-off.

Cross-Cultural Validation of the Preventive Health Model for Colorectal Cancer Screening: An Australian Study

We investigated whether the five-factor structure of the Preventive Health Model for colorectal cancer screening, developed in the United States, has validity in Australia. We also tested extending the model with the addition of the factor Self-Efficacy to Screen using Fecal Occult Blood Test (SESFOBT). Randomly selected men and women aged between 50 and 76 years (n = 414) responded to a survey. Confirmatory factor analyses indicated that the U.S. model provided adequate fit for the group as a whole and for men and women separately, thereby demonstrating cross-cultural validity for measuring factors influencing the decision to screen. The inclusion of SESFOBT in the model resulted in a comparable, but less parsimonious, fit. However, self-efficacy is a demonstrated mediator of intention and action, and it is argued that the addition of SESFOBT as a sixth factor may have utility for the design of strategies to increase actual uptake of FOBT.

Predictors of re-participation in faecal occult blood test- based screening for colorectal cancer.

BACKGROUND There is little information on longitudinal patterns of participation in faecal occult blood test (FOBT) based colorectal cancer (CRC) screening or on demographic or behavioural factors associated with participation in re-screening. The lack of an agreed system for describing participatory behaviour over multiple rounds also hampers our ability to report, understand and make use of observed associations. Our aims were to develop a system for describing patterns of participatory behaviour in FOBT-based CRC screening programs and to identify factors associated with particular behavioural patterns. METHOD A descriptive framework was developed and applied to a data extract of screening invitation outcomes over two rounds of the NBCSP. The proportion of invitees in each behaviour category was determined and associations between behaviour patterns and demographic and program factors were identified using multivariate analyses. RESULTS We considered Re- Participants, Dropouts, Late Entrants and Never Participants to be the most appropriate labels for the four possible observed participatory categories after two invitation rounds. The screening participation rate of the South Australian cohort of the NBCSP remained stable over two rounds at 51%, with second round Dropouts (10.3%) being balanced by Late Entrants (10.5%). Non-Participants comprised 38.7% of invitees. Relative to Re-Participants, Dropouts were older, more likely to be female, of lower SES, had changed their place of residence between offers had a positive test result in the first round. Late Entrants tended to be in the youngest age band. CONCLUSIONS Specific demographic characteristics are associated with behavioural sub-groups defined by responses to 2 offers of CRC screening. Targeted group-specific strategies could reduce dropout behaviour or encourage those who declined the first invitation to participate in the second round. It will be important to keep first round participants engaged in order to maximise the benefit of a CRC screening program.

Internet access for delivery of health information to South Australians older than 50

Objective: An exploratory study to determine the proportion of people aged 50‐76 years who have Internet access, the location of this access, predictive characteristics of such access, and preparedness to receive unsolicited health information through this medium.

Decision Support and the Effectiveness of Web-based Delivery and Information Tailoring for Bowel Cancer Screening: An Exploratory Study

Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study. Objective To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials. Methods Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool. Results Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.” Conclusions This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper.

Self-reported bowel screening rates in older Australians and the implications for public health screening programs.

BACKGROUND This paper sought to determine the status of older Australians with regard to Bowel Cancer screening practices occurring outside of the National Bowel Cancer Screening Program. METHOD A random sample of N=25,511 urban Australians aged 50 to 74 years received a questionnaire via mail asking questions relating to bowel screening. N=8,762 (34.3%) returned a completed questionnaire. RESULTS Approximately 33% (N=2863) of respondents indicated they had undergone colonoscopy in the preceding five years and 21% (N=1840) had used a Faecal Occult Blood Test (FOBT) in the preceding 12 months. Furthermore, 27% (N=497) of those who had completed an FOBT had also undergone colonoscopy. CONCLUSION A significant proportion of older Australians might be participating in bowel screening practices outside of the national program (NBCSP). Moreover, the proportion of individuals reporting use of both FOBT and endoscopic services is much higher than the positivity rate of FOBT. Large population FOBT screening programs, such as the NBCSP, that do not consider participation in screening external to the program may underestimate true population screening rates.

Ambivalence and Its Influence on Participation in Screening for Colorectal Cancer

Colorectal cancer (CRC) is one of the most prevalent cancers worldwide, and an ideal target for early detection and prevention through cancer screening. Unfortunately, rates of participation in screening are less than adequate. In this article we explore why people who were offered a fecal immunochemical test for CRC decided to participate or not, and for those who did participate, what influenced them to take action and complete the test. We conducted four focus groups and 30 telephone interviews with 63 people. The main reason people decided to screen was “wanting to know” their CRC status, which operated on a continuum ranging from wanting to know, through varying degrees of ambivalence, to not wanting to know. The majority of participants expressed ambivalence about CRC screening, and the main cue to action was the opportunity to screen without being too inconvenienced.

The information needs of adult cancer survivors across the cancer continuum: A scoping review

OBJECTIVE To provide an updated synthesis of the literature that investigates the self-reported information needs of people diagnosed with cancer across the cancer continuum. METHODS We conducted a scoping review of the literature published from August 2003 to June 2015 and expanded an existing typology summarizing the information needs of people diagnosed with cancer. RESULTS The majority of the included studies (n=104) focused on questions relevant to the diagnosis/active treatment phase of the cancer continuum (52.9%) and thus the most frequently identified information needs related to this phase (33.4%). Information needs varied across the continuum and the results highlight the importance of recognising this fact. CONCLUSION People diagnosed with cancer experience discrete information needs at different points from diagnosis to survival. Much of the research conducted in this area has focused on their information needs during the diagnosis and treatment of cancer, and literature relating to information needs following completion of treatment is sparse. PRACTICE IMPLICATIONS Further research is needed to discern the specific nature of the treatment concerns and identify the information needs that survivors experience during recurrence of cancer, metastasis or changes in diagnosis, and the end of life phase of the cancer continuum.