Perioperative Cardiovascular Evaluation for Orthotopic Liver Transplantation.

Patients with advanced liver disease have a high prevalence of cardiovascular risk factors, but many of them are asymptomatic. Cardiovascular risk stratification prior to liver transplant can be done by dobutamine stress echocardiography, stress myocardial perfusion imaging, cardiac computer tomography, and coronary angiography, but there are no clear recommendations regarding what method should be used and who should be screened. Because of this and because of inherent risk profile in this population, the variations in practice are significant. Careful screening and rigorous management of cardiovascular risk factors are important to ensure optimal cardiovascular outcomes in the immediate post-transplantation period and in the long term as well.

Adjunctive anticoagulation during peripheral vascular intervention.

Endovascular techniques for the treatment of peripheral arterial disease are becoming an increasingly common alternative to open surgery, yet the degree of anticoagulation and choice of anticoagulant to optimize outcomes in these procedures remain uncertain. To date, few randomized trials have directly compared different anticoagulants for use during peripheral vascular interventions. It is also unclear if the approach to anticoagulation should be individualized to each vascular bed or if common principles are shared among them. This has led practitioners across different specialties to use a variety of different methods for anticoagulation, with most extrapolated from techniques used in percutaneous coronary interventions. In this review, we analyze the current literature for anticoagulation used during peripheral vascular intervention of the lower extremity, renal, carotid, and aortic arteries, with special consideration to the choice of anticoagulant used to maximize safe and effective procedural outcomes.

Online advertising by three commercial breast imaging services: message takeout and effectiveness.

Mammography is widely acknowledged to be the most cost-effective technique for population screening for breast cancer. Recently in Australia, imaging modalities other than mammography, including thermography, electrical impedance, and computerised breast imaging, have been increasingly promoted as alternative methods of breast cancer screening. This study assessed the impact of three commercial breast imaging companies' promotional material upon consumers' beliefs about the effectiveness of the companies' technology in detecting breast cancer, and consumers' intentions to seek more information or consider having their breasts imaged by these modalities. Results showed 90% of respondents agreed that the companies' promotional material promoted the message that the advertised breast imaging method was effective in detecting breast cancer, and 80% agreed that the material promoted the message that the imaging method was equally or more effective than a mammogram. These findings have implications for women's preference for and uptake of alternative breast imaging services over mammography.

Beliefs about bowel cancer among the target group for the National Bowel Cancer Screening Program in Australia.

OBJECTIVE: To assess awareness of and intentions and self-reported participation in the National Bowel Cancer Screening Program (NBCSP) in Australia and the program's impact on knowledge of and beliefs about bowel cancer. METHOD: Cross-sectional, computer-assisted telephone surveys of Western Australians aged 55-74 years conducted in April 2007 (n = 505) and June 2008 (n = 500) measured beliefs about the prevalence of bowel cancer, its preventability, impact of early detection on life expectancy, knowledge of the symptoms and tests for bowel cancer, and awareness of and participation in the NBCSP. RESULTS: In 2008, awareness of the Program was 58%. Seventy-seven per cent of those invited to participate in the program agreed to do so. The vast majority believed bowel cancer to be preventable (83%), with early treatment making 'a great deal of difference' to life expectancy (85%). Awareness of blood in faeces as a sign of bowel cancer increased from 64% in 2007 to 75% in 2008 (p<0.01). Awareness of FOBT as a test for bowel cancer increased from 54% in 2007 to 70% in 2008 (p<0.01). CONCLUSIONS: The NBCSP appears to have increased knowledge of bowel cancer. IMPLICATIONS: Education and screening campaigns are required to further increase perceived prevalence of bowel cancer and to increase knowledge of symptoms and risk factors.

Encouraging young Western Australians to be smarter than smoking.

PURPOSE: Smarter than Smoking is a multistrategy statewide youth smoking intervention. This article describes key strategies and results from its inception in 1995 to 2005. DESIGN: Comprehensive evaluation included formative research and baseline and follow-up surveys. Triennial national surveys provided independent monitoring of adolescent smoking prevalence. SETTING: Western Australia. SUBJECTS: 10- to 15-year-olds. INTERVENTION: A multipronged strategy mix, including mass media, the Internet, sponsorship, school initiatives, publications, and advocacy. MEASURES: Smoking prevalence, media awareness, and attitudes toward smoking and campaign messages. ANALYSIS: Trend comparisons across the first decade of the project, along with descriptive statistics. RESULTS: Significant attitudinal and behavioral shifts were observed following media waves and over time. There was a steady increase in the proportion who had never smoked (from 40% in 1996 to 61% in 2005). Results also showed a significant decrease in smoking prevalence from 1996 to 2005, down from 28% to 7% among 14-year-olds and from 43% to 14% among 15-year-olds. CONCLUSIONS: Smarter than Smoking was effective in achieving positive shifts in awareness, attitudes, intentions, and behavior. Effectiveness appeared to have been enhanced by sustained long-term funding, youth involvement in strategy development, and a strong research and evaluation base.

Efficacy of breast cancer appeals for promoting physical activity.

BACKGROUND: We investigated the efficacy of breast cancer prevention messages in increasing intentions to be more active. METHOD: We randomly assigned 200 females aged 30-60 years to a breast cancer and physical activity message or a cardiovascular disease and physical activity message. RESULTS: The breast cancer message was more believable and slightly more motivating to increase physical activity than the cardiovascular disease message, and 72% of respondents in the breast cancer condition increased their intention to increase their physical activity. CONCLUSION: The benefit of reducing the risk of breast cancer can be used to motivate increased physical activity in women.

Impact of smoking images in magazines on the smoking attitudes and intentions of youth: an experimental investigation.

OBJECTIVE: To determine the effect of magazine incidental smoking imagery on youths' smoking intentions. METHODS: A magazine was developed incorporating photographs of smokers (Smoking Magazine). A second version of the magazine (Non-smoking Magazine) included these photographs with the tobacco paraphernalia digitally erased. Equal numbers of smokers and non-smokers aged 14-17 years (n = 357) were randomly assigned to look through one version of the magazine and then asked a series of questions. RESULTS: Smokers made more unprompted mention of smoking imagery than non-smokers after viewing Smoking Magazine (52% vs 34%; p<0.05). Smokers viewing Smoking Magazine were more likely to report an urge to smoke (54% vs 40%; p<0.05). Female non-smokers who viewed Smoking Magazine were more likely than those who viewed Non-smoking Magazine to state a future intention to smoke (13% vs 0%; p<0.05). Female smokers were more attracted to the male models appearing in Smoking Magazine than Non-smoking Magazine (49% vs 24%; p<0.05) and the opposite was true for female non-smokers (28% vs 52%; p<0.05). Female smokers were also marginally more likely to desire looking like the female models in Smoking Magazine (64% vs 46%; p = 0.06) but no difference was observed in the non-smoking females (46% vs 46%). Male smokers and non-smokers did not differ in their responses by magazine type. CONCLUSIONS: Incidental positive smoking imagery in magazines can generate the same sorts of consumer effects attributed to advertising in general, including tobacco advertising. Sex specific results of our study may be explained by the choice of smoking images used.

Public (Mis)understanding of the UV Index.

The ultraviolet index (UVI) has been regularly reported in Australia for a decade but utilisation remains extremely low ( approximately 5%). Blunden, Lower, and Slevin, in a 2004 Journal of Health communication article, suggest that Australians' understanding of the UVI is "good," and education to increase awareness of the index is therefore no longer warranted. To test this position, focus groups were conducted followed by an intercept survey of 404 residents of Perth, Western Australia, aged 16-44 years, to explore understanding and familiarity with the UVI. Results suggested that far from being "good," the familiarity and understanding of the UVI of at least half of Australians is poor. This was exemplified by the following: mean estimations of average UVI values in summer and winter being highly exaggerated (19.8 and 11.8, respectively); 61.2% not appreciating that the UVI is independent of temperature; at least 55.0% not appreciating that UV conditions peak at solar noon; and 23.3% of 22-44 year olds confusing the UVI with a "burn-time" measure. People who do not understand the UVI are unlikely to utilise it effectively. It therefore remains possible that utilisation of the UVI remains low because understanding is poor. Future efforts to improve utilisation of the UVI, particularly among those looking at new display formats, may therefore be ineffective, unless they also incorporate strategies to facilitate understanding of the measure.

People's perceptions of cancer survivability: implications for oncologists.

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

The relationship between youth's moral and legal perceptions of alcohol, tobacco and marijuana and use of these substances.

Youth's perceptions of the morality of alcohol and other drug use and the perceived legitimacy of laws regulating such use have received scant attention in the international public health literature. To date, the focus has mainly been on emphasizing the health and social disbenefits of substance use in an attempt to counter the perceived psychological benefits (positive expectancies) of use and peer reinforcement. Following exploratory qualitative research, a structured questionnaire was administered to a sample of 611 youths aged 14-17 years. Analysis of the data found that use of alcohol, tobacco and marijuana was directly related to moral perceptions: those considering use as 'wrong under any circumstance' were less likely to be users than those who considered it 'ok under some or any circumstance'. Substance use was also related to legitimacy perceptions: those who thought laws relating to alcohol, tobacco and marijuana use were justified were less likely to be users than those who thought these laws were not justified. The implications of these findings for future research and for the design of more effective intervention strategies are discussed. It is suggested that interventions including student discussion of the moral and legal issues surrounding substance use may prove effective in postponing or even preventing substance use, particularly tobacco and marijuana consumption, or reducing the excess use of these substances.

Efficacy of bowel cancer appeals for promoting physical activity.

ISSUE ADDRESSED: To investigate the potential efficacy of bowel cancer prevention messages in increasing intentions to be more physically active. METHODS: A convenience sample of 281 physically inactive persons aged 30-60 years was recruited in the Perth city centre and randomly assigned to a bowel cancer and physical activity message or a heart disease and physical activity message. After reading a booklet containing information about physical activity and its link either to bowel cancer (n = 141) or cardiovascular disease (n = 140), respondents filled in a self-completion questionnaire. The main response measures were impact on intentions to be more physically active, and perceived believability and relevance of the message. RESULTS: Perceived believability of the message was high in both conditions. Perceived personal relevance of the message was substantially lower in the bowel cancer than the cardiovascular disease condition. Overall, the cardiovascular disease condition achieved somewhat higher behavioural intentions than the bowel cancer condition. CONCLUSIONS: The finding that two in three respondents in the bowel cancer condition had increased intention to increase their level of physical activity provides support for the potential efficacy of promoting physical activity in reducing the risk of bowel cancer.

Western Australians' perceptions of the survivability of different cancers: implications for public education campaigns.

ISSUE ADDRESSED: People's decisions about whether to participate in cancer screening and to seek treatment are related to their perceptions of the survivability of cancer. However, there is little empirical evidence to suggest people's awareness of the survivability of different cancers. The object of the present study was to determine people's estimates of the survivability of 10 cancers. METHODS: In 2001, data were collected via computer-assisted telephone interviews with 1,501 randomly selected metropolitan and rural Western Australian adults. Participants were presented with a list of 10 cancers. Half the sample was asked to nominate the three most survivable, and half was asked to nominate the three least survivable cancers. RESULTS: Participants' rankings of the 10 cancers in terms of perceived survivability were consistent with cancer registry data, with the exception of bone cancer which was underrated. Respondents' average estimates of five-year survival rates were also accurate (+/- 2-6%) for cancers with relatively high survival rates such as breast, cervical, prostate, and other skin cancers, with the exception of melanoma, which was underestimated (20%). However, average estimated survival rates for cancers with low survivability, such as leukaemia, lung, and stomach cancers, were substantially overestimated, being 31%, 38% and 43% higher respectively. CONCLUSIONS: Western Australians appear to have a reasonable understanding of the relative survivability of various cancers but a poorer appreciation of actual survival rates.

Changes in beliefs about cancer in Western Australia, 1964-2001.

OBJECTIVE: To assess changes in people's knowledge and beliefs about cancer between 1964 and 2001. DESIGN: Questions in a 1964 survey of beliefs about cancer (randomly selected households) were replicated in a 2001 telephone survey (random-digit dialing). SETTING: Perth, Western Australia. PARTICIPANTS: 984 and 491 participants aged 20 years or older in the 1964 and 2001 surveys, respectively (response rates, 86.8% and 47.0%). MAIN OUTCOME MEASURES: Changes in knowledge and beliefs about cancer. RESULTS: Between 1964 and 2001, there were major improvements in knowledge about the causes of cancer, with several myths dispelled. In 1964, the proportion of Perth residents surveyed who believed that cancer is contagious was 20% (95% CI, 18%-22%), compared with 3% (95% CI, 2%-4%) in 2001. Similarly, the proportion who believed cancer is caused by "a knock" was 25% (95% CI, 22%-28%) in 1964, compared with 1% (95% CI, 0-2%) in 2001. Cancer screening participation rates also greatly improved, from 18% (95% CI, 16%-20%) in 1964 to 77% (95% CI, 73%-81%) in 2001. Changes in participants' sources of knowledge about cancer were also evident, with family members and television increasing markedly as sources of information. CONCLUSIONS: Improved education of the public in health matters over the past four decades appears to have had a major and positive impact on knowledge about cancer.

Evaluation of aid to diagnosis of pigmented skin lesions in general practice: controlled trial randomised by practice.

OBJECTIVES: To determine whether an aid to the diagnosis of pigmented skin lesions reduces the ratio of benign lesions to melanomas excised in general practice. DESIGN: Controlled trial randomised by practice. SETTING: General practices in Perth, Western Australia. PARTICIPANTS: 468 general practitioners in 223 practices. INTERVENTIONS: Intervention practices were given an algorithm and instant camera to assist with the diagnosis of pigmented skin lesions. All practices were given national guidelines on managing melanoma. MAIN OUTCOME MEASURES: Ratio of benign pigmented lesions to melanomas excised. Analyses conducted with and without inclusion of seborrhoeic keratoses. RESULTS: At baseline the ratios of benign to malignant lesions were lower in the intervention group than in the control group. During the trial period the ratios were higher in the intervention group (19:1 v 17:1 without seborrhoeic keratoses and 29:1 v 26:1 with seborrhoeic keratoses). After adjustment for patients' age, sex, and socioeconomic status, the ratio was 1.02 times higher (95% confidence interval 0.68 to 1.51, P = 0.94) in the intervention group when seborrhoeic keratoses were not included and 1.03 times higher (0.71 to 1.50, P = 0.88) when seborrhoeic keratoses were included. General practitioners in the intervention group were less likely than those in the control group to excise the most recent pigmented skin lesion they managed (22% v 48%, P < 0.001) and to refer the patient to a specialist (16% v 27%, P = 0.06). CONCLUSIONS: Provision of the algorithm and camera did not decrease the ratio of benign pigmented skin lesions to melanomas excised by general practitioners.

The word 'cancer': reframing the context to reduce anxiety arousal.

This study investigated reaction to the word 'cancer' versus the phrase 'a cancer' in two ways: (1) assessing associations to the spoken words 'cancer' or 'a cancer'; and (2) presenting participants with a situation where one person says to another in print. 'I have cancer' or 'I have a cancer'. The participants were a convenience sample of 112 adults (i.e. aged 18 years or over), 55 males and 57 females, recruited via a mall intercept survey in the Perth (Western Australia) central business district. Participants were randomly assigned to either the 'cancer' condition or the 'a cancer' condition. Both methods confirmed that cancer arouses primarily negative affective responses in the vast majority of people. It was hypothesised that using 'a cancer' might lead to less negative affect associations than just the word 'cancer'. This was found to be the case for the spoken word association technique, but not for the printed cartoon technique.