Nathan Dunn

Moderate alcohol consumption contributes to women's well-being through the menopausal transition

Objectives To examine the association of alcohol consumption with well-being in mid-aged Australian women, taking into account other lifestyle factors. Methods A prospective, observational study was carried out among 438 urban Australian women aged 45–55 years at baseline. They were assessed annually for 8 years using a questionnaire on health and lifestyle, including self-ratings of well-being and daily ‘hassles’. Statistical analyses were performed using cluster and repeated measures analyses. Results About 80% of the women had consumed alcohol in the week preceding the interview. Alcohol intake was weakly associated with well-being overall (p = 0.094). Women who consumed alcohol at moderate levels had higher well-being scores than non-drinkers or heavy drinkers, however, provided they were also non-smokers and exercised weekly or more (p for interaction = 0.023) (21% of all study participants). Everyday symptoms and stresses had a negative impact on well-being (all p values < 0.001). Conclusions Among women undergoing menopausal transition, well-being is positively associated with moderate alcohol consumption along with other lifestyle factors in a synergistic fashion, rather than any individual factor having a dominant or an independent effect.

Spatially Varying Coefficient Inequalities: Evaluating How the Impact of Patient Characteristics on Breast Cancer Survival Varies by Location.

An increasing number of studies have identified spatial differences in breast cancer survival. However little is known about whether the structure and dynamics of this spatial inequality are consistent across a region. This study aims to evaluate the spatially varying nature of predictors of spatial inequality in relative survival for women diagnosed with breast cancer across Queensland, Australia. All Queensland women aged less than 90 years diagnosed with invasive breast cancer from 1997 to 2007 and followed up to the end of 2008 were extracted from linked Queensland Cancer Registry and BreastScreen Queensland data. Bayesian relative survival models were fitted using various model structures (a spatial regression model, a varying coefficient model and a finite mixture of regressions model) to evaluate the relative excess risk of breast cancer, with the use of Markov chain Monte Carlo computation. The spatially varying coefficient models revealed that some covariate effects may not be constant across the geographic regions of the study. The overall spatial patterns showed lower survival among women living in more remote areas, and higher survival among the urbanised south-east corner. Notwithstanding this, the spatial survival pattern for younger women contrasted with that for older women as well as single women. This complex spatial interplay may be indicative of different factors impacting on survival patterns for these women.

Relative survival of patients with lymphoma in Queensland according to histological subtype

Objective: To evaluate relative survival of patients in Queensland with different lymphoma subtypes; to determine whether outcomes have improved with recent changes in treatment; to evaluate relative survival according to place of residence and socio‐economic status.

Effect of false-positive screening mammograms on rescreening in Western Australia.

TO THE EDITOR: Joyce contends in her recent article that “medical workforce supply levels follow a predictable, if lengthy, cycle between phases of shortage and surplus”.1 If this is the case, the scramble by the Australian Health Ministers’ Advisory Council (AHMAC) to find internships for graduating medical students2 represents a stunning lapse in workforce planning. Marked growth in student numbers has occurred since the early 2000s, and the approximate size of the 2012 graduating cohort has been known since 2009.1,3 Despite the expansion of intern places in recent years,1 a significant shortfall is predicted for 2013.4,5 Commonwealth-supportedplace students are guaranteed an internship after graduation, but domestic and international full-feepaying students might miss out. AHMAC is attempting to identify new intern placements.2,5 However, capacity issues exist along the workforce continuum,1 and the cannibalisation of senior prevocational and vocational positions to allow expansion of intern training will only shift the bottleneck. The shortfall of intern places is symptomatic of a much larger problem. This situation reflects the lack of explicit national policy regarding the contribution of former international full-fee students to the medical labour force. It also disregards Australia’s strategic objective of a self-sufficient health workforce. The Council of Australian Governments must take a leadership role and agree on a robust mechanism to better manage the entire training pipeline, linking input, throughput and output. The federal–state blame game needs to end. These issues are complex, but the lack of coordination has real-world consequences; not just for the future careers of these medical students, but also for the health care of Australians. Michael A Bonning Past Chair