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ABSTRACT: Background: Indigenous young people are disproportionately exposed to risk factors for poor mental health. Methodologically rigorous research will be critical in the development and evaluation of prevention and treatment programs. Research examining the mental health of Indigenous young people may have been undermined by poor measurement. The extent to which research has used measures with adequate psychometrics is unknown.Methods: MEDLINE, PsychINFO and PUBMED databases, were systematically searched to identify papers published between 1998-2008 measuring the mental health of Indigenous young people from Australia, Canada, New Zealand or the US. Data extracted included type of mental health instrument, psychometric analyses reported and results.Results: Fifty-four relevant studies were identified. Seventy-nine mental health instruments were used, and 18% were bespoke. Only 14% of instruments had been validated for the relevant Indigenous population. Few studies reported assessment of the reliability or validity of instruments. Data about both the reliability and validity of 10 measures were reported. None of the measures met the standards set by the review. Evidence of at least one type of reliability and validity was demonstrated for six measures.Conclusions: From 1998-2008 few studies of mental health in Indigenous young people used measurement instruments with previously determined reliability and validity.
Clinical Child Psychology and Psychiatry 06/2013;
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ABSTRACT: OBJECTIVE: Few population-based studies have assessed the needs of haematological cancer survivors or conducted international comparisons. We aimed to assess and compare the unmet needs of Australian and Canadian haematological cancer survivors. METHODS: Two cross-sectional datasets were analysed. Survivors were recruited from population-based cancer registries and sent a self-report survey containing the Survivors Unmet Needs Survey. Australians were aged 18-80 years at the time of study and diagnosed in the last 3 years. Canadians were diagnosed 1-5 years prior and aged 19 years and over at diagnosis. RESULTS: A total of 268 Australian and 169 Canadian survivors returned a completed survey. 'Dealing with feeling tired' was identified as the highest concern by survivors. Country (LRχ(2) = 4.0(1), p = 0.045) was associated with survivors reporting a 'high/very high' unmet need with 'worry about earning money,' with Australians reporting marginally nonsignificantly higher odds than Canadians (OR 2.1; 95% CI; 0.99, 4.3). Country was not significantly associated with any other outcome. Having a personal expense in the last month as a result of having cancer, younger age at diagnosis, female sex, vocational or other level education, and consulting a health care professional for cancer treatment or concerns about cancer in the last month were associated with multiple areas of need. CONCLUSIONS: Australian and Canadian haematological cancer survivors were found to experience similar levels of unmet needs. Overall, haematological cancer survivors may require additional assistance in dealing with feeling tired. Copyright © 2013 John Wiley & Sons, Ltd.
Psycho-Oncology 02/2013; · 3.34 Impact Factor
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BMC Medical Research Methodology 01/2013; 13(38). · 2.67 Impact Factor
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British Journal of General Practice 01/2013; · 1.83 Impact Factor
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ABSTRACT: Self-reported weight and height is frequently used to quantify overweight and obesity. It is however, associated with limitations such as bias and poor agreement, which may be a result of social desirability or difficulties with recall. Methods to reduce these biases would improve the accuracy of assessment of overweight and obesity using patient self-report. The level of agreement between self-reported and measured weight and height has not been widely examined in general practice patients.
Consenting patients, presenting for care within four hour sessions, were randomly allocated to the informed or uninformed group. Participants were notified either a) prior to (informed group), or b) after (uninformed group) reporting their weight and height using a touchscreen computer questionnaire, that they would be measured. The differences in accuracy of self-report between the groups were examined by comparing mean differences, intraclass correlations (ICCs), Bland Altman plot with limits of agreement (LOAs) and Cohen's kappa. Overall agreement was assessed using similar statistical methods.
Of consenting participants, 32% were aged between 18-39 years, 42% between 40-64 years and 25% were 65 years and above. The informed group (n = 172) did not report their weight and height more accurately than the uninformed group (n = 160). Mean differences between self-reported and measured weight (p = 0.4004), height (p = 0.5342) and body mass index (BMI) (p = 0.4409) were not statistically different between the informed and uninformed group. Overall, there were small mean differences (-1.2 kg for weight, 0.8 for height and -0.6 kg/m2 for BMI) and high ICCs (>0.9) between self-reported and measured values. A substantially high kappa (0.70) was obtained when using self-reported weight and height relative to measured values to quantify the proportion underweight, normal weight, overweight or obese. While the average bias of self-reported weight and height as estimates of the measured quantities is small, the LOAs indicate that substantial discrepancies occur at the individual level.
Informing patients that their weight and height would be measured did not improve accuracy of reporting. The use of self-reported weight and height for surveillance studies in this setting appears acceptable; however this measure needs to be interpreted with care when used for individual patients.
BMC Medical Research Methodology 01/2013; 13:38. · 2.67 Impact Factor
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ABSTRACT: To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks' gestation among pregnant Aboriginal and Torres Strait Islander women.
Randomised controlled trial.Setting and participants: Pregnant Aboriginal and Torres Strait Islander women (n = 263) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009.
A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit, using evidence-based communication skills and engaging the woman's partner and other adults in supporting the quit attempts. Nicotine replacement therapy was offered after two failed attempts to quit. The control ("usual care") group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits.
Self-reported smoking status (validated with a urine cotinine measurement) between 36 weeks' gestation and delivery.
Participants in the intervention group (n = 148) and usual care group (n = 115) were similar in baseline characteristics, except that there were more women who had recently quit smoking in the intervention group than the control group. At 36 weeks, there was no significant difference between smoking rates in the intervention group (89%) and the usual care group (95%) (risk ratio for smoking in the intervention group relative to usual care group, 0.93 [95% CI, 0.86-1.08]; P = 0.212). Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis.
An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Islander women to quit smoking during pregnancy. Contamination of the intervention across groups, or the nature of the intervention itself, may have contributed to this result.
Australian New Zealand Clinical Trials Registry ACTRN12609000929202.
The Medical journal of Australia 07/2012; 197(1):42-6. · 2.81 Impact Factor
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ABSTRACT: Chronic 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.
This 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.
A 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.
These 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.
Environmental Health 06/2012; 11:38. · 2.65 Impact Factor
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ABSTRACT: Obesity 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.
Adult patients completed a touchscreen computer survey while waiting for their appointment. Responses from 1335 patients in twelve Australian practices are reported.
A 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.
A 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.
BMC Family Practice 05/2012; 13:48. · 1.80 Impact Factor
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ABSTRACT: PURPOSE: Use of the Distress Thermometer (DT) as a screening tool is increasing across the cancer trajectory. This study examined the accuracy and optimal cut-off score of the DT compared to the Hospital Anxiety and Depression Scale (HADS) for detecting possible cases of psychological morbidity among adults in early survivorship. METHODS: This study is a cross-sectional survey of 1,323 adult cancer survivors recruited from two state-based cancer registries in Australia. Participants completed the DT and the HADS at 6 months post-diagnosis. RESULTS: Compared to the HADS subscale threshold ≥8, the DT performed well in discriminating between cases and non-cases of anxiety, depression and comorbid anxiety-depression with an area under the curve of 0.85, 0.84 and 0.87, respectively. A DT cut-off score of ≥2 was best for clinical use (sensitivity, 87-95 %; specificity, 60-68 %), ≥4 was best for research use (sensitivity, 67-82 %; specificity, 81-88 %) and ≥3 was the best balance between sensitivity (77-88 %) and specificity (72-79 %) for detecting cases of anxiety, depression and comorbid anxiety-depression. The DT demonstrated a high level of precision in identifying non-cases of psychological morbidity at all possible thresholds (negative predictive value, 77-99 %). CONCLUSIONS: The recommended DT cut-off score of ≥4 was not supported for universal use among recent cancer survivors. The optimal DT threshold depends upon whether the tool is being used in the clinical or research setting. The DT may best serve to initially identify non-cases as part of a two-stage screening process. The performance of the DT against 'gold standard' clinical interview should be evaluated with cancer survivors.
Supportive Care in Cancer 05/2012; · 2.09 Impact Factor
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ABSTRACT: Adolescents and young adult (AYA) cancer survivors may have unique physical, psychological and social needs due to their cancer occurring at a critical phase of development. The aim of this study was to develop a psychometrically rigorous measure of unmet need to capture the specific needs of this group.
Items were developed following a comprehensive literature review, focus groups with AYAs, and feedback from health care providers, researchers and other professionals. The measure was pilot tested with 32 AYA cancer survivors recruited through a state-based cancer registry to establish face and content validity. A main sample of 139 AYA cancer patients and survivors were recruited through seven treatment centres and invited to complete the questionnaire. To establish test-retest reliability, a sub-sample of 34 participants completed the measure a second time. Exploratory factor analysis was performed and the measure was assessed for internal consistency, discriminative validity, potential responsiveness and acceptability.
The Cancer Needs Questionnaire - Young People (CNQ-YP) has established face and content validity, and acceptability. The final measure has 70 items and six factors: Treatment Environment and Care (33 items); Feelings and Relationships (14 items); Daily Life (12 items); Information and Activities (5 items); Education (3 items); and Work (3 items). All domains achieved Cronbach's alpha values greater than 0.80. Item-to-item test-retest reliability was also high, with all but four items reaching weighted kappa values above 0.60.
The CNQ-YP is the first multi-dimensional measure of unmet need which has been developed specifically for AYA cancer patients and survivors. The measure displays a strong factor structure, and excellent internal consistency and test-retest reliability. However, the small sample size has implications for the reliability of the statistical analyses undertaken, particularly the exploratory factor analysis. Future studies with a larger sample are recommended to confirm the factor structure of the measure. Longitudinal studies to establish responsiveness and predictive validity should also be undertaken.
Health and Quality of Life Outcomes 01/2012; 10:13. · 2.11 Impact Factor
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ABSTRACT: Colorectal cancer (CRC) is among the leading causes of cancer-related morbidity and mortality worldwide. Despite clinical practice guidelines to guide surveillance care for those who have completed treatment for this disease as well as screening for first degree relatives of people with CRC, the level of uptake of these recommendations remains uncertain. If outcomes for both patients and their families are to be improved, it is important to establish systematic and cost-effective interventions to improve adherence to guideline recommendations for CRC surveillance and screening.
A randomized controlled trial will be used to test the effectiveness of a print-based intervention to improve adherence to colonoscopy surveillance among people with CRC and adherence to CRC screening recommendations among their first degree relatives (FDRs). People diagnosed with CRC in the past 10 months will be recruited through a population-based cancer registry. Consenting participants will be asked if their first degree relatives might also be willing to participate in the trial. Information on family history of CRC will be obtained from patients at baseline. Patients and their families will be randomized to either minimal ethical care or the print-based intervention. The print-based intervention for FDRs will be tailored to the participant's level of risk of CRC as determined by the self-reported family history assessment. Follow up data on surveillance and screening participation will be collected from patients and their FDRs respectively at 12, 24 and 36 months' post recruitment. The primary analyses will relate to comparing levels of guideline adherence in usual care group versus print-based group in the patient sample and the FDR sample respectively.
Results of this study will provide contribute to the evidence base about effective strategies to a) improve adherence to surveillance recommendation for people with CRC; and b) improve adherence to screening recommendation for FDRs of people with CRC. The use of a population-based cancer registry to access the target population may have significant advantages in increasing the reach of the intervention.
This trial is registered with the Australian and New Zealand Clinical Trials Registry Registration Number (ACTRN): ACTRN12609000628246.
BMC Cancer 01/2012; 12:62. · 3.01 Impact Factor
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ABSTRACT: INTRODUCTION: Cardiovascular disease (CVD) and cancer are leading causes of death globally. Early detection of cancer and risk factors for CVD may improve health outcomes and reduce mortality. General practitioners (GPs) are accessed by the majority of the population and play a key role in the prevention and early detection of chronic disease risk factors. This cross-sectional study aims to assess the acceptability of an electronic method of data collection in general practice patients. The study will describe the proportion screened in line with guidelines for CVD risk factors and cancer as well as report the prevalence of depression, lifestyle risk factors, level of provision of preconception care, cervical cancer vaccination and bone density testing. Lastly, the study will assess the level of agreement between GPs and patients perception regarding presence of risk factors and screening. METHODS AND ANALYSIS: The study has been designed to maximise recruitment of GPs by including practitioners in the research team, minimising participation burden on GPs and offering remuneration for participation. Patient recruitment will be carried out by a research assistant located in general practice waiting rooms. Participants will be asked regarding the acceptability of the touch screen computer and to report on a range of health risk and preventive behaviours using the touch screen computer. GPs will complete a one-page survey indicating their perception of the presence of risk behaviours in their patients. Descriptive statistics will be generated to describe the acceptability of the touch screen and prevalence of health risk behaviours. Cohen's κ will be used to assess agreement between GP and patient perception of presence of health risk behaviours. ETHICS AND DISSEMINATION: This study has been approved by the human research committees in participating universities. Findings will be disseminated via peer-reviewed publications, conference presentations as well as practice summaries provided to participating practices.
BMJ open. 01/2012; 2(4).
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Mohammad Rafiqul Islam,
Ismail Khan,
John Attia,
Sheikh Mohammad Nazmul Hassan,
Mark McEvoy, Catherine D'Este,
Syed Azim,
Ayesha Akhter,
Shahnaz Akter,
Sheikh Mohammad Shahidullah,
Abul Hasnat Milton
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ABSTRACT: Chronic arsenic exposure and its association with hypertension in adults are inconclusive and this cross-sectional study investigated the association. The study was conducted between January and July 2009 among 1,004 participants from 1,682 eligible women and men aged ≥30 years living in rural Bangladesh who had continuously consumed arsenic-contaminated drinking water for at least 6 months. Hypertension was defined as systolic blood pressure ≥140 mmHg (systolic hypertension) and diastolic blood pressure ≥90 mmHg (diastolic hypertension). Pulse pressure was calculated by deducting diastolic from systolic pressure and considered to be increased when the difference was ≥55 mmHg. The prevalence of hypertension was 6.6% (95% CI: 5.1-8.3%). After adjustment for other factors, no excess risk of hypertension was observed for arsenic exposure >50μg/L or to that of arsenic exposure as quartiles or as duration. Arsenic concentration as quartiles and >50 μg/L did show a strong relationship with increased pulse pressure (adjusted OR: 3.54, 95% CI: 1.46-8.57), as did arsenic exposure for ≥10 years (adjusted OR: 5.25, 95% CI: 1.41-19.51). Arsenic as quartiles showed a dose response relationship with increased pulse pressure. Our study suggests an association between higher drinking water arsenic or duration and pulse pressure, but not hypertension.
International Journal of Environmental Research and Public Health 01/2012; 9(12):4522-4536. · 1.61 Impact Factor
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ABSTRACT: Several trials have shown that iron-folic acid supplements during pregnancy protect newborns against preterm delivery and early neonatal death, but the impact beyond the neonatal period is unclear.
We determined whether live-born children <5 y of age born to mothers who used antenatal iron-folic acid supplements had reduced risk of death.
Pooled 1994, 1997, 2002-2003, and 2007 Indonesia Demographic and Health Survey data were used to examine the relation between the use of iron-folic acid supplements and child death in 3 cumulative (0-30 d, 0-11 mo, and 0-4 y) and 4 mutually exclusive (first day of life and 1-30 d, 1-11 mo, and 1-4 y of age) time periods. Risk of death was estimated by using Cox regression to control for 19 potential confounders.
Survival information for 52,917 singleton live-born infants and 1525 deaths of children <5 y of age was examined. After adjustment for potential confounders, risk of death of children <5 y of age was reduced significantly by 34% if the mother consumed any iron-folic acid supplements [adjusted HR (aHR): 0.66; 95% CI: 0.53, 0.81; P < 0.001]. This protective effect was greatest for deaths on the first day of life (aHR: 0.40; 95% CI: 0.21, 0.77; P = 0.005) but was also shown for neonatal deaths on days 1-30 of life (aHR: 0.69; 95% CI: 0.49, 0.97; P = 0.035) and postneonatal deaths (aHR: 0.74; 95% CI: 0.56, 0.99; P = 0.044). There was a strong dose response of greater protection from death of children <5 y of age with increasing numbers of iron-folic acid supplements consumed.
In developing countries increased use of antenatal iron-folic acid supplements will reduce deaths of children <5 y of age, especially in the first year of life.
American Journal of Clinical Nutrition 12/2011; 95(1):220-30. · 6.67 Impact Factor
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Sandy Middleton,
Patrick McElduff,
Jeanette Ward,
Jeremy M Grimshaw,
Simeon Dale, Catherine D'Este,
Peta Drury,
Rhonda Griffiths,
N Wah Cheung,
Clare Quinn,
Malcolm Evans,
Dominique Cadilhac,
Christopher Levi
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ABSTRACT: We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence-based management of fever, hyperglycaemia, and swallowing dysfunction in acute stroke units (ASUs).
In the Quality in Acute Stroke Care (QASC) study, a single-blind cluster randomised controlled trial, we randomised ASUs (clusters) in New South Wales, Australia, with immediate access to CT and on-site high dependency units, to intervention or control group. Patients were eligible if they spoke English, were aged 18 years or older, had had an ischaemic stroke or intracerebral haemorrhage, and presented within 48 h of onset of symptoms. Intervention ASUs received treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction with multidisciplinary team building workshops to address implementation barriers. Control ASUs received only an abridged version of existing guidelines. We recruited pre-intervention and post-intervention patient cohorts to compare 90-day death or dependency (modified Rankin scale [mRS] ≥2), functional dependency (Barthel index), and SF-36 physical and mental component summary scores. Research assistants, the statistician, and patients were masked to trial groups. All analyses were done by intention to treat. This trial is registered at the Australia New Zealand Clinical Trial Registry (ANZCTR), number ACTRN12608000563369.
19 ASUs were randomly assigned to intervention (n=10) or control (n=9). Of 6564 assessed for eligibility, 1696 patients' data were obtained (687 pre-intervention; 1009 post-intervention). Results showed that, irrespective of stroke severity, intervention ASU patients were significantly less likely to be dead or dependent (mRS ≥2) at 90 days than control ASU patients (236 [42%] of 558 patients in the intervention group vs 259 [58%] of 449 in the control group, p=0·002; number needed to treat 6·4; adjusted absolute difference 15·7% [95% CI 5·8-25·4]). They also had a better SF-36 mean physical component summary score (45·6 [SD 10·2] in the intervention group vs 42·5 [10·5] in the control group, p=0·002; adjusted absolute difference 3·4 [95% CI 1·2-5·5]) but no improvement was recorded in mortality (21 [4%] of 558 in intervention group and 24 [5%] of 451 in the control group, p=0·36), SF-36 mean mental component summary score (49·5 [10·9] in the intervention group vs 49·4 [10·6] in the control group, p=0·69) or functional dependency (Barthel Index ≥60: 487 [92%] of 532 patients vs 380 [90%] of 423 patients; p=0·44).
Implementation of multidisciplinary supported evidence-based protocols initiated by nurses for the management of fever, hyperglycaemia, and swallowing dysfunction delivers better patient outcomes after discharge from stroke units. Our findings show the possibility to augment stroke unit care.
National Health & Medical Research Council ID 353803, St Vincent's Clinic Foundation, the Curran Foundation, Australian Diabetes Society-Servier, the College of Nursing, and Australian Catholic University.
The Lancet 11/2011; 378(9804):1699-706. · 38.28 Impact Factor
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Radiotherapy and Oncology 10/2011; 101(3):525-6. · 5.58 Impact Factor
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ABSTRACT: This study examined the internal and external validity of the Memory Complaint Questionnaire (MAC-Q), a brief measure of subjective memory complaint in people with normal cognitive function.
The Study of Health Outcomes in Aircraft Maintenance Personnel was a retrospective cohort study investigating the association between aircraft fuel tank deseal/reseal activities and health status in Royal Australian Air Force personnel. Cross-sectional comparison tests included measures of executive functioning, psychomotor speed, attention/working memory, new learning/memory, depression, and anxiety. An adjusted regression analysis accounted for confounders including age, dates of posting, rank, education, alcohol use, tobacco use, and affective status.
Eight hundred seventy-nine participants completed the MAC-Q. Although the MAC-Q tested as highly reliable and internally valid, it was highly associated with affective status and was only associated with Digit Symbol Coding after adjustment for depression/anxiety.
The MAC-Q is greatly influenced by affective status but not memory performance. It is probably not useful as a specific screen of memory complaint for general population research.
Journal of clinical epidemiology 08/2011; 65(2):199-205. · 2.96 Impact Factor
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ABSTRACT: The objective was to assess the effectiveness of a volunteer-delivered tailored telephone-based intervention in reducing prevalence of unmet supportive care needs, elevated levels of anxiety and depression among people with colorectal cancer over a 9-month period.
There were 653 participants who completed the baseline questionnaire and were randomised to usual care (n = 341) or intervention (n = 306). Three follow-up questionnaires were completed at 3-monthly intervals (response rates: 93%, 87%, 82%, respectively). All four questionnaires contained the Supportive Care Needs Survey (SCNS), Hospital Anxiety and Depression Scale (HADS) and checklists for colorectal cancer symptoms and use of support services. The intervention consisted of trained volunteers providing emotional support, service referral and information and was delivered after completion of each of the first three questionnaires. Primary outcomes were prevalence of moderate to high SCNS needs and elevated levels (scores of 8+) of HADS anxiety and depression.
Over the study period, SCNS needs decreased similarly for both groups, and prevalence of elevated depression did not change for either group. There was a greater reduction in the prevalence of elevated anxiety in the intervention than usual care group (p < 0.01), with the intervention group decrease mainly occurring between baseline and the first follow-up survey (p < 0.01). However, the prevalence of elevated anxiety was similar between the two groups at each follow-up point.
The intervention had no effect on supportive care needs or depression, although it may be associated with a greater reduction in anxiety. Future research should test the intervention with patients closer to diagnosis. Copyright © 2011 John Wiley & Sons, Ltd.
Psycho-Oncology 07/2011; 21(10):1053-62. · 3.34 Impact Factor
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ABSTRACT: To study the effect of Baroque music in people with dementia.
Patients in a multicultural dementia-specific aged care facility were subjected to Baroque music in a cross-over study.
There were significantly more behavioural disturbances during the weeks when Baroque music was played compared to control periods (0.2 more episodes per week, P = 0.01), and more episodes in the afternoon shift compared to evening shift (1 more episode per week, P = 0.001).
These results confirm that music can influence behaviour but is contrary to previous results.
Australasian Journal on Ageing 03/2011; 30(1):11-5. · 0.90 Impact Factor
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James W Denham,
Allison Steigler,
David S Lamb,
David Joseph,
Sandra Turner,
John Matthews,
Chris Atkinson,
John North,
David Christie,
Nigel A Spry,
Keen-Hun Tai,
Chris Wynne, Catherine D'Este
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ABSTRACT: The TROG 96.01 trial assessed whether 3-month and 6-month short-term neoadjuvant androgen deprivation therapy (NADT) decreases clinical progression and mortality after radiotherapy for locally advanced prostate cancer. Here we report the 10-year results.
Between June, 1996, and February, 2000, 818 men with T2b, T2c, T3, and T4 N0 M0 prostate cancers were randomly assigned to receive radiotherapy alone, 3 months of NADT plus radiotherapy, or 6 months of NADT plus radiotherapy. The radiotherapy dose for all groups was 66 Gy, delivered to the prostate and seminal vesicles (excluding pelvic nodes) in 33 fractions of 2 Gy per day (excluding weekends) over 6·5-7·0 weeks. NADT consisted of 3·6 mg goserelin given subcutaneously every month and 250 mg flutamide given orally three times a day. NADT began 2 months before radiotherapy for the 3-month NADT group and 5 months before radiotherapy for the 6-month NADT group. Primary endpoints were prostate-cancer-specific mortality and all-cause mortality. Treatment allocation was open label and randomisation was done with a minimisation technique according to age, clinical stage, tumour grade, and initial prostate-specific antigen concentration (PSA). Analysis was by intention-to-treat. The trial has been closed to follow-up and all main endpoint analyses are completed. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12607000237482.
802 men were eligible for analysis (270 in the radiotherapy alone group, 265 in the 3-month NADT group, and 267 in the 6-month NADT group) after a median follow-up of 10·6 years (IQR 6·9-11·6). Compared with radiotherapy alone, 3 months of NADT decreased the cumulative incidence of PSA progression (adjusted hazard ratio 0·72, 95% CI 0·57-0·90; p=0·003) and local progression (0·49, 0·33-0·73; p=0·0005), and improved event-free survival (0·63, 0·52-0·77; p<0·0001). 6 months of NADT further reduced PSA progression (0·57, 0·46-0·72; p<0·0001) and local progression (0·45, 0·30-0·66; p=0·0001), and led to a greater improvement in event-free survival (0·51, 0·42-0·61, p<0·0001), compared with radiotherapy alone. 3-month NADT had no effect on distant progression (0·89, 0·60-1·31; p=0·550), prostate cancer-specific mortality (0·86, 0·60-1·23; p=0·398), or all-cause mortality (0·84, 0·65-1·08; p=0·180), compared with radiotherapy alone. By contrast, 6-month NADT decreased distant progression (0·49, 0·31-0·76; p=0·001), prostate cancer-specific mortality (0·49, 0·32-0·74; p=0·0008), and all-cause mortality (0·63, 0·48-0·83; p=0·0008), compared with radiotherapy alone. Treatment-related morbidity was not increased with NADT within the first 5 years after randomisation.
6 months of neoadjuvant androgen deprivation combined radiotherapy is an effective treatment option for locally advanced prostate cancer, particularly in men without nodal metastases or pre-existing metabolic comorbidities that could be exacerbated by prolonged androgen deprivation.
Australian Government National Health and Medical Research Council, Hunter Medical Research Institute, AstraZeneca, and Schering-Plough.
The lancet oncology 03/2011; 12(5):451-9. · 14.47 Impact Factor
