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Hughes AM, Ponsonby AL, Dear K, Dwyer T, Taylor BV, van der Mei I, Valery PC, Lucas RM. Childhood infections, vaccinations, and tonsillectomy and risk of first clinical diagnosis of CNS demyelination in the Ausimmune Study. Mult Scler Relat Disord 2020; 42:102062. [PMID: 32305688 DOI: 10.1016/j.msard.2020.102062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between childhood vaccinations and infections and risk of multiple sclerosis is unclear; few studies have considered age at vaccination/infection. OBJECTIVE To explore age-related associations between childhood vaccinations, infection and tonsillectomy and risk of a first clinical diagnosis of CNS demyelination. METHODS Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported age at time of childhood vaccinations, infections, and tonsillectomy. Conditional logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS Poliomyelitis vaccination prior to school-age was associated with increased risk of a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02-6.68), based on a very small unvaccinated reference group. Late (11-15 years) rubella vaccination (compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI 0.27-0.83). Past infectious mononucleosis at 11-15 years (AOR = 2.84, 95%CI 1.0-7.57) and 16-20 years (AOR = 1.92, 95%CI 1.12-3.27) or tonsillectomy in adolescence (11-15 years: AOR = 2.45, 95%CI 1.12-5.35), including after adjustment for IM, were associated with increased risk of a first clinical diagnosis of CNS demyelination. CONCLUSIONS Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS demyelination. Failing to account for age effects may explain inconsistencies in past findings.
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Affiliation(s)
- A M Hughes
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; The Canberra Hospital, Canberra, Australia
| | - A-L Ponsonby
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - K Dear
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - T Dwyer
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - B V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.
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2
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Garvey G, Cunningham J, Janda M, Yf He V, Valery PC. Psychological distress among Indigenous Australian cancer survivors. Support Care Cancer 2017; 26:1737-1746. [PMID: 29243167 DOI: 10.1007/s00520-017-3995-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study is to identify the level of and factors associated with distress in 155 Indigenous Australian cancer survivors approximately 6 months post-diagnosis. METHODS The distress thermometer (DT) was used to assess clinically significant distress (defined as having a DT score ≥ 4). Logistic regression was used to identify sociodemographic and clinical factors associated with clinically significant distress. RESULTS The mean distress score was 2.7 (SD 2.9), with about one in three Indigenous cancer survivors reporting clinically significant distress (35%; n = 54). After adjusting for age and sex, clinically significant distress was more likely among those who were separated/divorced/widowed than those who were married (odds ratio (OR) = 2.99, 95% confidence intervals (95% CI) 1.21-7.35, p = 0.017) and less likely among those residing in remote areas than those in major cities (OR = 0.23, 95% CI 0.08-0.71, p = 0.001) and in those receiving non-surgical treatment only compared with surgery only (OR = 0.24, 95% CI 0.08-0.68, p = 0.008). CONCLUSIONS Despite increased screening for distress in cancer care, this is, to our knowledge, the first published assessment of distress among Indigenous Australian cancer survivors. The characteristics of Indigenous cancer survivors associated with greater likelihood of clinically significant distress indicate at-risk subgroups who would benefit from screening and early intervention. Further research is required to identify the specific aetiologies of distress. Our findings indicate a need to identify psychological distress and for survivorship care to include culturally sensitive and tailored psychological support for Indigenous cancer survivors.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia.
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia
| | - M Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD, 4006, Australia
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3
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Bernardes CM, Martin J, Cole P, Kitchener T, Cowburn G, Garvey G, Walpole E, Valery PC. Lessons learned from a pilot study of an Indigenous patient navigator intervention in Queensland, Australia. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28513056 DOI: 10.1111/ecc.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 01/08/2023]
Abstract
Indigenous patient navigator (IPN) programmes show promise in addressing barriers to cancer care and facilitation of patient self-efficacy. The purpose of this paper is to describe and reflect upon the experience of training an IPN and implementation of the intervention in the Australian context with Indigenous cancer patients. Randomised clinical trial might provide the best available evaluation measure of an intervention but caution should be taken in the implementation process. Socio-cultural aspects and training can affect the conduct of this type of intervention. We report here five issues needing consideration prior to implementing such intervention. Specifically: (1) recognition of the collective bonds within Indigenous community and understanding by IPN of the degree of personal assistance perceived as not intrusive by the patient; (2) conduct ongoing evaluation of the different role of an IPN involved in this intervention care provider vs. researcher. (3) meaningful engagement develops from a trusting/collaborative relationship between research team and study site staff which may not occur in the study time frame; (4) existing skills as well as training provided may not translate in the IPN understanding and aligning with the study objectives/research values; (5) recruitment of participants requires innovative and highly flexible strategies to be successful.
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Affiliation(s)
- C M Bernardes
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Brisbane, QLD, Australia
| | - J Martin
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - P Cole
- Ipswich Hospital, Brisbane, QLD, Australia
| | - T Kitchener
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - G Cowburn
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - G Garvey
- Menzies School of Health Research, Brisbane, QLD, Australia.,Charles Darwin University, Darwin, NT, Australia
| | - E Walpole
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Menzies School of Health Research, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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4
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Meiklejohn JA, Adams J, Valery PC, Walpole ET, Martin JH, Williams HM, Garvey G. Health professional's perspectives of the barriers and enablers to cancer care for Indigenous Australians. Eur J Cancer Care (Engl) 2017; 25:254-61. [PMID: 26918690 DOI: 10.1111/ecc.12467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
To investigate health professionals' perspectives about factors that impede or facilitate cancer care for Indigenous people. Semi-structured interviews with 22 health professionals involved in Indigenous cancer care. Data were interpreted using an inductive thematic analysis approach. Participants presented their perspectives on a number of barriers and enablers to Indigenous cancer care. Barriers were related to challenges with communication, the health system and coordination of care, issues around individual and community priorities and views of cancer treatment and health professional judgement. Enablers to cancer care were related to the importance of trust and rapport as well as health care system and support factors. The findings highlighted the need for recording of Indigenous status in medical records and a coordinated approach to the provision of evidence-based and culturally appropriate cancer care. This could go some way to improving Indigenous patient's engagement with tertiary cancer care services.
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Affiliation(s)
- J A Meiklejohn
- Cancer Epidemiology, Menzies School of Health Research, Brisbane, Qld.,Cancer & Chronic Disease Research Group, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Brisbane, Qld
| | - J Adams
- Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - P C Valery
- Cancer & Chronic Disease Research Group, QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Brisbane, Brisbane, Qld.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - E T Walpole
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Metro South Health and Hospital Service/Medicine, University of Queensland, Brisbane, Qld, Australia
| | - J H Martin
- Clinical Pharmacology, University of Newcastle School of Medicine and Public Health, Mater Hospital, Waratah, NSW, Australia.,Southside Clinical School, University of Queensland, Brisbane, Qld, Australia
| | - H M Williams
- Epidemiology and Health Systems, Menzies School of Health Research, Brisbane, Qld, Australia
| | - G Garvey
- Epidemiology and Health Systems, Menzies School of Health Research, Brisbane, Qld, Australia
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5
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Meiklejohn JA, Garvey G, Bailie R, Walpole E, Adams J, Williamson D, Martin J, Bernardes CM, Arley B, Marcusson B, Valery PC. Follow-up cancer care: perspectives of Aboriginal and Torres Strait Islander cancer survivors. Support Care Cancer 2017; 25:1597-1605. [DOI: 10.1007/s00520-016-3563-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/27/2016] [Indexed: 12/27/2022]
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6
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Simpson S, Tan H, Otahal P, Taylor B, Ponsonby A, Lucas RM, Blizzard L, Valery PC, Lechner‐Scott J, Shaw C, Williams D, Mei I. Anxiety, depression and fatigue at 5-year review following CNS demyelination. Acta Neurol Scand 2016; 134:403-413. [PMID: 26756925 DOI: 10.1111/ane.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Anxiety and depression are common in multiple sclerosis (MS). We evaluated the prevalence and factors associated with anxiety, depression and fatigue at the 5-year review of a longitudinal cohort study following a first clinical diagnosis of CNS demyelination (FCD). METHODS Cases with a FCD were recruited soon after diagnosis and followed annually thereafter. A variety of environmental, behavioural and clinical covariates were measured at five-year review. Anxiety and depression were measured using the Hospital Anxiety & Depression Scale (HADS), and fatigue by the Fatigue Severity Scale (FSS). RESULTS Of the 236 cases, 40.2% had clinical anxiety (median HADS-A: 6.0), 16.0% had clinical depression (median HADS-D: 3.0), and 41.3% had clinical fatigue (median FSS: 4.56). The co-occurrence of all three symptoms was 3.76 times greater than expectation. Younger age, higher disability, concussion or other disease diagnosis were independently associated with a higher anxiety score; male sex, higher disability, being unemployed, less physical activity, and antidepressant and/or anxiolytic-sedative medication use were independently associated with a higher depression score. Higher disability, immunomodulatory medication use, other disease diagnosis and anxiolytic-sedative medication use were independently associated with having fatigue, while female sex, higher BMI, having had a concussion, being unemployed and higher disability were associated with a higher fatigue score. CONCLUSION These results support previous findings of the commonality of anxiety, depression and fatigue in established MS and extend this to post-FCD and early MS cases. The clustering of the three symptoms indicates that they may share common antecedents.
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Affiliation(s)
- S. Simpson
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - H. Tan
- School of Medicine University of Tasmania Hobart TAS Australia
| | - P. Otahal
- School of Medicine University of Tasmania Hobart TAS Australia
| | - B. Taylor
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - A.‐L. Ponsonby
- Murdoch Children's Research Institute University of Melbourne Parkville VIC Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health The Australian National University Canberra ACT Australia
| | - L. Blizzard
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
| | - P. C. Valery
- QIMR Berghofer Medical Research Institute Brisbane QLD Australia
| | - J. Lechner‐Scott
- Dept. Neurology John Hunter Hospital New Lambton NSW Australia
- University of Newcastle Callaghan NSW Australia
| | - C. Shaw
- School of Medicine Faculty of Health Deakin University Geelong VIC Australia
| | - D. Williams
- Dept. Neurology John Hunter Hospital New Lambton NSW Australia
- University of Newcastle Callaghan NSW Australia
| | - I. Mei
- Menzies Institute for Medical Research University of Tasmania Hobart TAS Australia
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7
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Thewes B, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, He VY, Yip D, Garvey G. Routine screening of Indigenous cancer patients' unmet support needs: a qualitative study of patient and clinician attitudes. Int J Equity Health 2016; 15:90. [PMID: 27286811 PMCID: PMC4902957 DOI: 10.1186/s12939-016-0380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Indigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care. Methods Forty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed. Results Indigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff. Conclusions Staff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.
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Affiliation(s)
- B Thewes
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, New South Wales, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia.
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8
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van der Mei I, Lucas RM, Taylor BV, Valery PC, Dwyer T, Kilpatrick TJ, Pender MP, Williams D, Chapman C, Otahal P, Ponsonby AL. Population attributable fractions and joint effects of key risk factors for multiple sclerosis. Mult Scler 2016; 22:461-9. [PMID: 26199349 DOI: 10.1177/1352458515594040] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 04/01/2015] [Indexed: 03/25/2024]
Abstract
AIM We examined the combined effect of having multiple key risk factors and the interactions between the key risk factors of multiple sclerosis (MS). METHODS We performed an incident case-control study including cases with a first clinical diagnosis of central nervous system demyelination (FCD) and population-based controls. RESULTS Compared to those without any risk factors, those with one, two, three, and four or five risk factors had increased odds of being an FCD case of 2.12 (95% confidence interval (CI), 1.11-4.03), 4.31 (95% CI, 2.24-8.31), 7.96 (95% CI, 3.84-16.49), and 21.24 (95% CI, 5.48-82.40), respectively. Only HLA-DR15 and history of infectious mononucleosis interacted significantly on the additive scale (Synergy index, 3.78; p = 0.03). The five key risk factors jointly accounted for 63.8% (95% CI, 43.9-91.4) of FCD onset. High anti-EBNA IgG was another important contributor. CONCLUSIONS A high proportion of FCD onset can be explained by the currently known risk factors, with HLA-DR15, ever smoking and low cumulative sun exposure explaining most. We identified a significant interaction between HLA-DR15 and history of IM in predicting an FCD of CNS demyelination, which together with previous observations suggests that this is a true interaction.
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Affiliation(s)
| | - R M Lucas
- National Centre for Epidemiology and Population Health, The Australian National University, Australia
| | | | - P C Valery
- Queensland Institute of Medical Research, Australia
| | - T Dwyer
- International Agency for Research on Cancer, France
| | - T J Kilpatrick
- Centre for Neuroscience, The University of Melbourne, Australia
| | - M P Pender
- Department of Neurophysiology, John Hunter Hospital, Australia
| | - D Williams
- Department of Neurophysiology, John Hunter Hospital, Australia
| | - C Chapman
- Department of Neurology, Barwon Health, Australia
| | - P Otahal
- Menzies Research Institute, Australia
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Diaz A, Bernardes CM, Garvey G, Valery PC. Supportive care needs among Indigenous cancer patients in Queensland, Australia: less comorbidity is associated with greater practical and cultural unmet need. Eur J Cancer Care (Engl) 2016; 25:242-53. [PMID: 26918689 DOI: 10.1111/ecc.12471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/28/2022]
Abstract
Little is known about the supportive care needs (SCN) of Australian Indigenous cancer patients. This cross-sectional study investigated the association between comorbidity and SCN among newly diagnosed Indigenous cancer patients in Queensland. Comorbidity was ascertained from medical chart review using the Charlson Comorbidity Index (CCI) and SCN were measured using the Supportive Care Needs Assessment Tool for Indigenous Peoples (SCNAT-IP). Of 183 participants, 76 (42%) had no comorbidity (CCI = 0), 60 (33%) had had a CCI score of 1 and 47 (26%) had a CCI of two or more, with the most common condition being diabetes (30%). The most common moderate-high unmet need items varied between comorbidity groups, although all patients most frequently reported moderate-high unmet need in the Physical and Psychological and the Practical and Cultural needs domains. Patients with the greatest comorbidity (CCI ≥ 2) had significantly more reduced odds of practical and cultural needs than patients without comorbidity (OR 0.28, 95% CI 0.11-0.75). This appeared to be partially explained by time since diagnosis, age, whether they were receiving current treatment and residential remoteness. Patients' experience of chronic disease, hospitals and the healthcare system may better prepare them for the practical and cultural aspects of their cancer journey.
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Affiliation(s)
- A Diaz
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia
| | - C M Bernardes
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia.,QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia
| | - P C Valery
- Menzies School of Health Research, Charles Darwin University, Brisbane, Qld, Australia.,QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
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10
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Garvey G, Cunningham J, He VY, Janda M, Baade P, Sabesan S, Martin JH, Fay M, Adams J, Kondalsamy-Chennakesavan S, Valery PC. Health-related quality of life among Indigenous Australians diagnosed with cancer. Qual Life Res 2016; 25:1999-2008. [PMID: 26831052 DOI: 10.1007/s11136-016-1233-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) and associated factors were assessed among 155 Indigenous Australian adult cancer patients 6 months post-diagnosis. METHODS The Assessment of Quality of Life-4D Questionnaire was used to assess HRQoL. Differences in the median utility score among subgroups of interest were examined using nonparametric tests. Factors associated with excellent HRQoL were assessed through logistic regression. RESULTS Participants' mean age was 52 years (range 20-78), and the majority were female (60 %), unemployed (72 %), and recruited from outpatients clinics (64 %). Breast cancer (27 %) was the most common diagnosis. The median HRQoL score was 0.62; 14 % of participants reported excellent HRQoL (>0.90). After adjusting for age, admission status, and treatment, excellent HRQoL was more likely among participants of Torres Strait Islander origin [adjusted odds ratio (AOR) 3.68; 95 % CI 1.23-11.01], those living in regional areas (AOR 5.59; 95 % CI 1.42-22.06), and those whose main language spoken at home was not English (AOR 3.60; 95 % CI 1.08-11.99) and less likely among those reporting less contact with Indigenous people (AOR 0.23; 95 % CI 0.68-0.81). CONCLUSION Assessing HRQoL is important to identifying and improving the length and quality of cancer survivorship, especially in groups that have significantly poorer cancer outcomes, such as Indigenous Australians. Acknowledging the study's observational nature, we found HRQoL was lower than reported for other Australians, and we identified some socio-demographic factors that were associated with excellent HRQoL. Such assessments are an important component of identifying and evaluating appropriate interventions to improve the health and well-being of Indigenous cancer patients.
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Affiliation(s)
- G Garvey
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia.
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - M Janda
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - P Baade
- Cancer Council Queensland, Brisbane, Australia
| | - S Sabesan
- College of Medicine and Dentistry, James Cook University and Townsville Hospital, Townsville, Australia
| | - J H Martin
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - M Fay
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - P C Valery
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
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11
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Diaz A, Moore SP, Martin JH, Green AC, Garvey G, Valery PC. Comorbidities amongst Indigenous Cancer Patients: Impact on Treatment and Survival. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Diaz A, Moore SP, Martin JH, Green AC, Coory M, Garvey G, Valery PC. Early Diagnosis and Improved Treatment Uptake in the First Year may Reduce Survival Disparities between Aboriginal and Torres Strait Islander and other Australian Women Diagnosed with Gynaecological Cancer. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Garvey G, Thewes B, He VFY, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, Jones V, Yip D. Indigenous cancer patient and staff attitudes towards unmet needs screening using the SCNAT-IP. Support Care Cancer 2015; 24:215-223. [PMID: 26003424 DOI: 10.1007/s00520-015-2770-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Indigenous Australians have a higher cancer incidence, worse mortality and are less likely to receive optimal cancer treatment compared with non-Indigenous Australians. Culturally appropriate supportive care helps ensure that Indigenous patients engage in and receive optimal care. However, many existing supportive care needs tools lack cultural relevance for Indigenous people, and their feasibility with Indigenous people has not been demonstrated. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) assesses the unmet supportive care needs of Indigenous cancer patients. PURPOSE This descriptive study evaluates the clinical implementation of the SCNAT-IP in routine care. METHODS Two large tertiary cancer treatment centres and two regional oncology clinics participated. Participants included 10 clinical staff and 36 adult Indigenous cancer patients (mean age 54 years). Patients and clinicians completed brief, purpose-designed questionnaires and interviews. RESULTS Patients reported high ratings (means >8/10) for acceptability, helpfulness and timing items. The majority (≥80%) of staff agreed that the SCNAT-IP was useful to clinical practice, should be used in routine care and was acceptable to their patients. CONCLUSIONS The study provides empirical support for the feasibility and acceptability of the SCNAT-IP in routine cancer care with Indigenous Australians. Routine screening with the SCNAT-IP has the potential to improve cancer care for Indigenous people with cancer.
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Affiliation(s)
- G Garvey
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia.
| | - B Thewes
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - V F Y He
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - V Jones
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
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Valery PC, Lucas RM, Williams DB, Pender MP, Chapman C, Coulthard A, Dear K, Dwyer T, Kilpatrick TJ, McMichael AJ, van der Mei I, Taylor BV, Ponsonby AL. Occupational exposure and risk of central nervous system demyelination. Am J Epidemiol 2013; 177:954-61. [PMID: 23585328 DOI: 10.1093/aje/kws361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inconsistent evidence exists regarding the association between work-related factors and risk of multiple sclerosis (MS). We examined the association between occupational exposures and risk of a first clinical diagnosis of central nervous system demyelination (FCD), which is strongly associated with progression to MS, in a matched case-control study of 276 FCD cases and 538 controls conducted in Australia (2003-2006). Using a personal residence and work calendar, information on occupational history and exposure to chemicals and animals was collected through face-to-face interviews. Few case-control differences were noted. Fewer cases had worked as professionals (≥6 years) than controls (adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI): 0.37, 0.96). After further adjustment for number of children, cases were more likely to have ever been exposed to livestock than controls (AOR = 1.54, 95% CI: 1.03, 2.29). Among women, there was an increase in FCD risk associated with 10 or more years of exposure to livestock (AOR = 2.78, 95% CI: 1.22, 6.33) or 6 or more years of farming (AOR = 2.00, 95% CI: 1.23, 3.25; also adjusted for number of children). Similar findings were not evident among men. Thus, farming and exposure to livestock may be important factors in the development of FCD among women, with this finding further revealed after the confounding effect of parity or number of children is considered.
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Ponsonby AL, Lucas RM, van der Mei IA, Dear K, Valery PC, Pender MP, Taylor BV, Kilpatrick TJ, Coulthard A, Chapman C, Williams D, McMichael AJ, Dwyer T. Offspring number, pregnancy, and risk of a first clinical demyelinating event: the AusImmune Study. Neurology 2012; 78:867-74. [PMID: 22402857 DOI: 10.1212/wnl.0b013e31824c4648] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the association between past pregnancy, offspring number, and first clinical demyelination risk. METHODS Cases (n = 282) were aged 18-59 years with a first clinical diagnosis of CNS demyelination (first clinical demyelinating event [FCD]) and resident within 1 of 4 Australian centers (from latitudes 27° south to 43° south) from 2003 to 2006. Controls (n = 542) were matched to cases on age, sex, and study region, without first clinical diagnosis of CNS demyelination. RESULTS Higher offspring number was associated with FCD risk among women (p < 0.001) but not men (p = 0.71); difference in effect; p = 0.001. Among women, higher parity was associated with reduced risk of FCD (adjusted odds ratio 0.51 [95% confidence interval 0.36, 0.72] per birth) with a similar magnitude of effect observed among classic first demyelinating events (adjusted odds ratio 0.47 [95% confidence interval 0.29, 0.74]). The apparent beneficial effect of higher parity was also evident among parous women only (p < 0.001). Among cases, a clear female excess was evident for those with low but not high (4 or more) offspring number. Factors such as human leukocyte antigen DR15 genotype did not appear to modify the association between higher parity and a reduced FCD risk among women. CONCLUSIONS These findings are consistent with a cumulative beneficial effect of pregnancy. Temporal changes toward an older maternal age of parturition and reduced offspring number may partly underlie the increasing female excess among MS cases over time.
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Affiliation(s)
- A-L Ponsonby
- Murdoch Childrens Research Institute, Melbourne, Australia.
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Lucas RM, Ponsonby AL, Dear K, Valery PC, Pender MP, Taylor BV, Kilpatrick TJ, Dwyer T, Coulthard A, Chapman C, van der Mei I, Williams D, McMichael AJ. Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology 2011; 76:540-8. [DOI: 10.1212/wnl.0b013e31820af93d] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Baade PD, Youlden DR, Valery PC, Hassall T, Ward L, Green AC, Aitken JF. Population-based survival estimates for childhood cancer in Australia during the period 1997-2006. Br J Cancer 2010; 103:1663-70. [PMID: 21063404 PMCID: PMC2994235 DOI: 10.1038/sj.bjc.6605985] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study provides the latest available relative survival data for Australian childhood cancer patients. METHODS Data from the population-based Australian Paediatric Cancer Registry were used to describe relative survival outcomes using the period method for 11,903 children diagnosed with cancer between 1983 and 2006 and prevalent at any time between 1997 and 2006. RESULTS The overall relative survival was 90.4% after 1 year, 79.5% after 5 years and 74.7% after 20 years. Where information onstage at diagnosis was available (lymphomas, neuroblastoma, renal tumours and rhabdomyosarcomas), survival was significantly poorer for more-advanced stage. Survival was lower among infants compared with other children for those diagnosed with leukaemia, tumours of the central nervous system and renal tumours but higher for neuroblastoma. Recent improvements in overall childhood cancer survival over time are mainly because of improvements among leukaemia patients. CONCLUSION The high and improving survival prognosis for children diagnosed with cancer in Australia is consistent with various international estimates. However, a 5-year survival estimate of 79% still means that many children who are diagnosed with cancer will die within 5 years, whereas others have long-term health morbidities and complications associated with their treatments. It is hoped that continued developments in treatment protocols will result in further improvements in survival.
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Affiliation(s)
- P D Baade
- [1] Viertel Centre for Research in Cancer Control, Cancer Council Queensland, 553 Gregory Terrace, GPO Box 201 Spring Hill, Fortitude Valley QLD 4006, Australia.
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Abstract
We conducted a cross-sectional study of Indigenous youths residing in the Torres Strait region of Australia to assess the prevalence of obesity and the metabolic syndrome. Data on body mass index (BMI), waist circumference, blood pressure, presence of acanthosis nigricans and blood glucose were collected. Fasting glucose, insulin, C-Peptide, HbA1c and lipids were measured, and an oral glucose tolerance test was performed in those with a BMI greater than 25 (childhood-equivalent cut-points) or fasting glucometer reading >5.5 mmol/L. Of 158 youths, 31% were overweight and 15% were obese, 38% had enlarged waist circumference consistent with central obesity, 43% had acanthosis nigricans and 27% were hypertensive. More females than males had enlarged waist circumferences (59% vs. 13%, P < 0.001). Among overweight or obese youth, 56% had significantly elevated insulin (P = 0.021); they also had higher HOMA-IR (P = 0.002). The metabolic syndrome was present in 17% of all youths (mostly females) and in 33% of the overweight or obese subgroup. Type 2 diabetes was diagnosed in two youths. These very high proportions of overweight or obese Torres Strait youth with metabolic risk factors have major public health implications.
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Affiliation(s)
- P C Valery
- Queensland Institute of Medical Research and The Australian Centre for International and Tropical Health, University of Queensland, Queensland, Australia.
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Chang AB, Hills YC, Cox NC, Cleghorn GJ, Valery PC, Lewindon PJ, Ee LC, Withers GD, Beem C, Hills BA. 'Free' surfactant in gastric aspirates and bronchoalveolar lavage in children with and without reflux oesophagitis. Intern Med J 2006; 36:226-30. [PMID: 16640739 DOI: 10.1111/j.1445-5994.2006.01041.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Dipalmitoylphosphatidycholine (DPPC) is the characteristic and main constituent of surfactant. Adsorption of surfactant to epithelial surfaces may be important in the masking of receptors. The aims of the study were to (i) compare the quantity of free DPPC in the airways and gastric aspirates of children with gastroesophageal reflux disease (GORD) to those without and (ii) describe the association between free DPPC levels with airway cellular profile and capsaicin cough sensitivity. METHODS Children aged <14 years were defined as 'coughers' if a history of cough in association with their GORD symptoms was elicited before gastric aspirates and nonbronchoscopic bronchoalveolar lavage (BAL) were obtained during elective flexible upper gastrointestinal endoscopy. GORD was defined as histological presence of reflux oesophagitis. Spirometry and capsaicin cough-sensitivity test was carried out in children aged >6 years before the endoscopy. RESULTS Median age of the 68 children was 9 years (interquartile range (IQR) 7.2). Median DPPC level in BAL of children with cough (72.7 microg/mL) was similar to noncoughers (88.5). There was also no significant difference in DPPC levels in both BAL and gastric aspirates of children classified according to presence of GORD. There was no correlation between DPPC levels and cellular counts or capsaicin cough-sensitivity outcome measures. CONCLUSION We conclude that free DPPC levels in the airways and gastric aspirate is not influenced by presence of cough or GORD defined by histological presence of reflux oesophagitis. Whether quantification of adsorbed surfactant differs in these groups remain unknown. Free DPPC is unlikely to have a role in masking of airway receptors.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland, Australia.
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Abstract
OBJECTIVE Respiratory health of Indigenous and minority ethnic groups in affluent countries is poorer than their non-minority counterparts and sleep disorders are no exception. In children, obstructive sleep apnoea has the potential to result in serious long-term consequences. In 1999, we studied 1650 children and adolescents living in the Torres Strait and the Northern Peninsula Area, Australia. Here we report prevalence of snoring in these communities and relate its association with asthma symptoms. METHODS A population-based cross-sectional study was conducted in the Torres Strait region. Five indigenous communities were randomly selected and information was collected using a structured face-to-face interview based on a standardized questionnaire. There was a 98% response rate, and 1650 children, 0-17 years of age, were included in the study. RESULTS Overall, the prevalence of snoring was 14.2% (95% CI 12.5-15.9); 3.6% (95% CI 2.7-4.6) reported snorting, and 6% (95% CI 4.9-7.2) reported restless sleep. The prevalence of snoring was significantly higher among males (17.1% for males and 10.8 for females, P = 0.005). Children were five times more likely to have experienced snoring and snorting if they reported wheezing in the last 12 months. CONCLUSION We conclude that the prevalence of symptoms suggestive of obstructive sleep problems is relatively high in children of this region. This highlights the need for awareness among the community patients and physicians about the problem of obstructive sleep-disordered breathing, especially in children with asthma, and for the need for further studies to measure prevalence of sleep breathing disorders among Indigenous Australians.
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Affiliation(s)
- P C Valery
- Queensland Institute of Medical Research, Population and Clinical Sciences Division, The Australian Centre for International and Tropical Health and Nutrition, University of Queensland.
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Valery PC, Chang AB, Shibasaki S, Gibson O, Purdie DM, Shannon C, Masters IB. High prevalence of asthma in five remote indigenous communities in Australia. Eur Respir J 2001; 17:1089-96. [PMID: 11491149 DOI: 10.1183/09031936.01.00099901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data on the prevalence of asthma in children residing in remote indigenous communities in Australia are sparse, despite the many reports of high prevalence in nonindigenous children of this country. Two previous Australian studies have had poor participation rates, limiting interpretation of their results. A study of children in the Torres Strait and Northern Peninsula Area of Australia was conducted to document the prevalence of asthma symptoms. Five indigenous communities were randomly selected and trained interviewers, who were local indigenous health workers, recruited participants using a house-by-house approach. Information was collected by a structured face-to-face interview based on a standardized questionnaire constructed from the protocol International Study of Asthma and Allergy in Childhood; 1,650 children were included in the study with a 98% response rate. Overall, the prevalence of self-reported ever wheezing was 21%; 12% reported wheezing in the previous year; and 16% reported ever having asthma. There was significant variation in the prevalence of asthma symptoms between communities. It is concluded that there are significant intercommunity variations in the prevalence of asthma symptoms in remote communities and that the prevalence in these communities is as high as in nonindigenous groups.
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Affiliation(s)
- P C Valery
- Epidemiology and Population Health Division, Queensland Institute of Medical Research, Royal Brisbane Hospital, Australia
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Valery PC, Williams G, Mcwhirter W, Sleigh A, Scott D, Bain C. Electronic telephone directory listings: preferred sampling frame for a population-based study of childhood cancer in Australia. Ann Epidemiol 2000; 10:504-8. [PMID: 11118929 DOI: 10.1016/s1047-2797(00)00070-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE We report our telephone-based system for selecting community control series appropriate for a complete Australia-wide series of Ewing's sarcoma cases. METHODS We used electronic directory random sampling to select age-matched controls. The sampling has all listed telephone numbers on an up-dated CD-Rom. RESULTS 95% of 2245 telephone numbers selected were successfully contacted. The mean number of attempts needed was 1.94, 58% answering at the first attempt. On average, we needed 4.5 contacts per control selected. Calls were more likely to be successful (reach a respondent) when made in the evening (except Saturdays). The overall response rate among contacted telephone numbers was 92.8%. Participation rates among female and male respondents were practically the same. The exclusion of unlisted numbers (13.5% of connected households) and unconnected households (3.7%) led to potential selection bias. However, restricting the case series to listed cases only, plus having external information on the direction of potential bias allow meaningful interpretation of our data. CONCLUSION Sampling from an electronic directory is convenient, economical and simple, and gives a very good yield of eligible subjects compared to other methods.
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Affiliation(s)
- P C Valery
- Queensland Institute of Medical Research, Queensland, Australia.
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Abstract
OBJECTIVE To investigate Australian adults' awareness of the ultraviolet (UV) indexes forecast in the media, and whether these UV forecasts influence their behaviour in the sun. METHODS A self-administered questionnaire was used on two occasions in 1997 to ask about knowledge of UV indexes shown in the media and about possible influence on outdoor behaviour. SETTING AND PARTICIPANTS Participants were 977 residents (423 men; 554 women) of Nambour originally randomly selected in 1986 from the electoral roll, who have been followed up subsequently. RESULTS The majority of people--92% of men and 86% of women--reported having seen or heard the UV indexes forecast during summer. Of these, significantly fewer men (107; 28%) than women (209; 46%) reported that their outdoor behaviour was influenced by knowledge of the forecast (p = 0.001). Neither age nor skin type, nor history of sunburns or skin cancer, affected knowledge of UV forecasts or their influence on behaviour. CONCLUSIONS AND IMPLICATIONS Although most people are aware of the forecasts of UV indexes in the media, the majority do not take them into account in their outdoor behaviour. Compared with women, men were more aware of, but less influenced by, forecasts of UV indexes. Better communication of the implications of the UV indexes is needed, particularly to men, if they are to adapt their outdoor behaviour to improve their sun protection.
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Chang AB, Shannon C, O'Neil MC, Tiemann AM, Valery PC, Craig D, Fa'Afoi E, Masters IB. Asthma management in indigenous children of a remote community using an indigenous health model. J Paediatr Child Health 2000; 36:249-51. [PMID: 10849226 DOI: 10.1046/j.1440-1754.2000.00505.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the management of asthma in children in a remote indigenous community and the delivery of subspecialist service through the indigenous health-care model. METHODOLOGY Children referred by indigenous health-care workers were evaluated prospectively by paediatric respiratory physicians, based on a standardized protocol, at a primary health care setting at Thursday Island, Queensland. RESULTS Forty of the 54 children referred with a provisional diagnosis of asthma did have asthma, with 30% having persistent asthma. Only 59% of parents knew the dose of the medication prescribed and 80% had minimal knowledge of the medications. In 88% of children, the management of asthma was improved by introduction of an appropriate spacer device and changing the dose and type of medications. CONCLUSIONS The management of children with asthma in the Torres region can be improved substantially by the use of age appropriate delivery devices and medications, and improving knowledge of asthma. Specialist delivery service to remote indigenous communities can be effectively delivered in partnership with the indigenous health service. The high proportion of persistent asthma in the Torres Straits community in comparison to urbanised Australia raises issues of inequity of appropriate medical service delivery to remote indigenous communities.
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Affiliation(s)
- A B Chang
- Department of Respiratory Medicine, Mater Misericordiae Children's Hospital, South Brisbane, Queensland.
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