Michelle L. Fraser

Defining exclusive breastfeeding in Australia.

Abstract:  Exclusive breastfeeding for the first 6 months of life is recommended as the optimal way to feed infants. This paper reviews the measurement of exclusive breastfeeding in Australian studies over the past 10 years. Only half the studies identified that claimed to measure exclusive breastfeeding used a definition consistent with the World Health Organisation. Three studies used 24‐h or 7‐day recall indicators that have been shown to produce overestimations of the prevalence of exclusive breastfeeding. Measurement of exclusive breastfeeding with a valid and consistent definition is vital for monitoring rates and trends, for comparison between different studies and countries and to reach conclusions on various health benefits. Any future measurement of exclusive breastfeeding in Australia should use the World Health Organisation definition and the 24 h recall study design should not be used for this purpose.

Protective effects of green tea against prostate cancer

Prostate cancer has the third highest incidence of all cancers in men worldwide with incidence and mortality being particularly high in affluent, developed countries. Tea, especially green tea, has demonstrated promise in the prevention of several cancers. Green tea contains several components including catechins, a category of polyphenols that have chemopreventive properties. Although evidence from epidemiological studies is not comprehensive, it is strengthened by animal and in vitro evidence suggesting that consumption of tea is associated with decreased risk or progression of prostate cancer. Emerging evidence and potential biological mechanisms for the role of green tea in prostate cancer prevention are presented in this review.

Lycopene and prostate cancer: emerging evidence

Prostate cancer has the third highest incidence of all cancers in men worldwide and is the most common neoplasm diagnosed among men beyond middle age in many developed countries. Mounting evidence surrounding the consumption of tomato products has shown promise for the prevention of prostate cancer. This protective effect has more recently been linked to lycopene, the most abundant carotenoid in tomatoes. Lycopene is a natural pigment that gives the red color to many foods. In Western countries, 85% of dietary lycopene can be attributed to the consumption of tomato-based products. This article reviews emerging evidence from epidemiologic studies for the role of lycopene in prostate cancer prevention. The majority of evidence currently comes from observational studies, but recent human clinical trials and animal studies have provided additional support. Growing evidence on the biologic mechanisms of lycopene in prostate cancer prevention also confirm the epidemiologic findings.

The impact of first- and second-eye cataract surgery on injurious falls that require hospitalisation: a whole-population study

BACKGROUND cataract is a leading cause of reversible vision impairment and may increase falls in older adults. OBJECTIVE to assess the risk of an injury due to a fall among adults aged 60+, 2 years before first-eye cataract surgery, between first-eye surgery and second-eye surgery and 2 years after second-eye surgery. DESIGN a retrospective cohort study. SETTING Western Australian Hospital Morbidity Data System and the Western Australian Death Registry. SUBJECTS there were 28,396 individuals aged 60+ years who underwent bilateral cataract surgery in Western Australia between 2001 and 2008. METHODS Poisson regression analysis based on generalised estimating equations compared the frequency of falls 2 years before first-eye cataract surgery, between first- and second-eye surgery and 2 years after second-eye cataract surgery after accounting for potential confounders. RESULTS the risk of an injurious fall that required hospitalisation doubled (risk ratio: 2.14, 95% confidence interval: 1.82 to 2.51) between first- and second-eye cataract surgery compared with the 2 years before first-eye surgery. There was a 34% increase in the number of injurious falls that required hospitalisation in the 2 years after second-eye cataract surgery compared with the 2 years before first-eye surgery (risk ratio: 1.34, 95% confidence interval: 1.16-1.55). CONCLUSIONS there was an increased risk of injurious falls after first- and second-eye cataract surgery which has implications for the timely provision of second-eye surgery as well as appropriate refractive management between surgeries.

Tea, coffee and prostate cancer

Worldwide, prostate cancer has the second highest incidence of all cancers in males with incidence and mortality being much higher in affluent developed countries. Risk and progression of the disease may be linked to both genetic and environmental factors, especially dietary factors. Tea and coffee are two of the most popular beverages in the world and have been investigated for possible effects on health outcomes, including cancer. However, very little dietary advice for their consumption exists. The evidence for a relationship between coffee or tea consumption and prostate cancer is reviewed in this paper. While current evidence indicates that coffee is a safe beverage, its consumption probably has no relationship with prostate cancer. Tea, especially green tea, has shown some potential in the prevention of prostate cancer. While evidence from epidemiologic studies is currently inconclusive, strong evidence has emerged from animal and in vitro studies. We also consider what level of evidence is required to make recommendations for preventive measures to the public. Although evidence on the relationship between coffee, tea and prostate cancer is not complete, we consider it strong enough to recommend tea as a healthier alternative to coffee.

Tea or coffee? A case study on evidence for dietary advice

The present paper explores the level of evidence required to justify giving dietary advice to the public. There are important practical differences between the development of public health nutrition guidelines and guidelines for clinical practice. While the gold standard for evidence for clinical practice guidelines is a meta-analysis of a number of randomised controlled trials, this is often unrealistic and sometimes unethical for the evaluation of public health nutrition interventions. Hence, epidemiological studies make up the bulk of evidence for nutrition guidelines. Tea and coffee are an interesting case study in relation to this issue. They are two of the most commonly consumed beverages worldwide, yet there is little dietary advice on their use. The evidence for a relationship between coffee or tea consumption and several diseases is discussed. The available studies, predominantly epidemiological, together with animal and in vitro studies, indicate that coffee and tea are both safe beverages. However, tea is the healthier option because it has a possible role in the prevention of several cancers and CVD. While the evidence for such relationships is not strong, the public will continue to drink both tea and coffee, and will continue to ask nutritionists to make recommendations. It is therefore argued that advice should be given on the best available data, as waiting for complete data to become available could have severe consequences for public health.

Vision, quality of life and depressive symptoms after first eye cataract surgery.

Cataract affects not only vision, but also performance of everyday tasks, participation in social activities, quality of life and possibly depression. Depression is a major health issue for older adults. It is estimated that 6%–20% of community‐dwelling older Australians experience depression. The aim of this study was to investigate changes in vision‐related quality of life and depressive symptoms after first eye cataract surgery and to determine which visual measures affect the change in these outcomes.

The impact of first eye cataract surgery on mental health contacts for depression and/or anxiety: a population-based study using linked data

Purpose:  Cataract is the leading cause of reversible blindness worldwide, and the incidence of cataract surgery is projected to increase as the population ages. Gaining an understanding of the effects of cataract surgery on a range of health outcomes is important for maintaining the health and safety of older adults.

Which visual measures affect change in driving difficulty after first eye cataract surgery

OBJECTIVE To investigate self-reported driving difficulty before and after first eye cataract surgery and determine which visual measures are associated with changes in self-reported driving difficulty after surgery. METHODS A cohort of 99 older drivers with bilateral cataract were assessed the week before and 12 weeks after first eye cataract surgery. Visual measures including visual acuity, contrast sensitivity, stereopsis and useful field of view were assessed. Self-reported driving difficulty was measured via the Driving Habits Questionnaire. Cognitive status was assessed using the Mini Mental State Examination. Regression analysis was undertaken to determine the association between changes in visual measures and self-reported driving difficulty after first eye cataract surgery. RESULTS Overall, self-reported driving difficulty improved after first eye cataract surgery. However, 16% of participants did not improve and driving difficulty worsened in 11% following surgery. Improvement in driving difficulty score after first eye cataract surgery was associated with improved contrast sensitivity in the operated eye (p<0.001), new glasses after surgery (p<0.001), and fewer chronic health conditions (p=0.016). CONCLUSION Contrast sensitivity rather than visual acuity was a significant factor affecting change in self-reported driving difficulty after first eye cataract surgery for bilateral patients. This has implications for driver licensing authorities worldwide that rely heavily on visual acuity as a measure of visual fitness to drive.

Driver self-regulation and depressive symptoms in cataract patients awaiting surgery: a cross-sectional study

BackgroundCataract is an extremely common visual condition of ageing. Evidence suggests that visual impairment influences driving patterns and self-regulatory behavior among older drivers. However, little is known about the psychological effects of driver self-regulation among older drivers. Therefore, this study aimed to describe driver self-regulation practices among older bilateral cataract patients and to determine the association between self-regulation and depressive symptoms.MethodsNinety-nine older drivers with bilateral cataract were assessed the week before first eye cataract surgery. Driver self-regulation was measured via the Driving Habits Questionnaire. Depressive symptoms were assessed using the 20-item Center for Epidemiological Studies Depression Scale. Visual, demographic and cognitive data were also collected. Differences between self-regulators and non self-regulators were described and linear regression modeling used to determine the association between driver self-regulation and depressive symptoms score.ResultsAmong cataract patients, 48% reported self-regulating their driving to avoid at least one challenging situation. The situations most commonly avoided were driving at night (40%), on the freeway (12%), in the rain (9%) and parallel parking (8%). Self-regulators had significantly poorer contrast sensitivity in their worse eye than non self-regulators (p = 0.027). Driver self-regulation was significantly associated with increased depressive symptoms after controlling for potential confounding factors (p = 0.002).ConclusionsDriver self-regulation was associated with increased depressive symptoms among cataract patients. Further research should investigate this association among the general older population. Self-regulation programs aimed at older drivers may need to incorporate mental health elements to counteract unintended psychological effects.