Psychometric properties of an Australian supportive care needs assessment tool for Indigenous patients with cancer.

BACKGROUND: There are significant disparities in cancer outcomes between Indigenous and non-Indigenous Australians. Identifying the unmet supportive care needs of Indigenous Australians with cancer is imperative to improve their cancer care. The purpose of the current study was to test the psychometric properties of a supportive cancer care needs assessment tool for Indigenous people (SCNAT-IP) with cancer. METHODS: The SCNAT-IP was administered to 248 Indigenous Australians diagnosed with a range of cancer types and stages, and who received treatment in 1 of 4 Queensland hospitals. All 39 items were assessed for ceiling and floor effects and were analyzed using exploratory factor analysis to determine construct validity. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools. RESULTS: Exploratory factor analysis revealed a 4-factor structure (physical and psychological, hospital care, information and communication, and practical and cultural needs) explaining 51% of the variance. Internal consistency of the 4 subscales was good, with Cronbach alpha reliability coefficients ranging from .70 to .89. Convergent validity was supported by significant correlations between the SCNAT-IP with the National Comprehensive Cancer Network Distress Thermometer (correlation coefficient [r] = 0.60; P<.001) and the Cancer Worry Chart (r = 0.58; P<.001) and a moderately strong negative correlation with the Assessment of Quality of Life questionnaire (r = -0.56; P<.001). CONCLUSIONS: These data provide initial support for the SCNAT-IP, a measure of multiple supportive care needs domains specific to Indigenous Australian patients with cancer undergoing treatment.

Viability of Pseudomonas aeruginosa in cough aerosols generated by persons with cystic fibrosis.

BACKGROUND: Person-to-person transmission of respiratory pathogens, including Pseudomonas aeruginosa, is a challenge facing many cystic fibrosis (CF) centres. Viable P aeruginosa are contained in aerosols produced during coughing, raising the possibility of airborne transmission. METHODS: Using purpose-built equipment, we measured viable P aeruginosa in cough aerosols at 1, 2 and 4 m from the subject (distance) and after allowing aerosols to age for 5, 15 and 45 min in a slowly rotating drum to minimise gravitational settling and inertial impaction (duration). Aerosol particles were captured and sized employing an Anderson Impactor and cultured using conventional microbiology. Sputum was also cultured and lung function and respiratory muscle strength measured. RESULTS: Nineteen patients with CF, mean age 25.8 (SD 9.2) years, chronically infected with P aeruginosa, and 10 healthy controls, 26.5 (8.7) years, participated. Viable P aeruginosa were detected in cough aerosols from all patients with CF, but not from controls; travelling 4 m in 17/18 (94%) and persisting for 45 min in 14/18 (78%) of the CF group. Marked inter-subject heterogeneity of P aeruginosa aerosol colony counts was seen and correlated strongly (r=0.73-0.90) with sputum bacterial loads. Modelling decay of viable P aeruginosa in a clinic room suggested that at the recommended ventilation rate of two air changes per hour almost 50 min were required for 90% to be removed after an infected patient left the room. CONCLUSIONS: Viable P aeruginosa in cough aerosols travel further and last longer than recognised previously, providing additional evidence of airborne transmission between patients with CF.

Frequency of sunburn in Queensland adults: still a burning issue.

OBJECTIVE: To assess the current frequency of sunburn, a preventable risk factor for skin cancer, among Queensland adults. DESIGN AND SETTING: Cross-sectional population-based surveys of 16 473 residents aged ≥ 18 2013s across Queensland in 2009 and 2010. MAIN OUTCOME MEASURES: Proportion of the adult population reporting sunburn (skin reddening lasting 12 hours or more) during the previous weekend, by age, sex and other risk factors. RESULTS: One in eight men and one in 12 women in Queensland reported being sunburnt on the previous weekend. Age up to 65 2013s was the strongest predictor of sunburn: eg, people aged 18-24 2013s were seven times more likely (adjusted odds ratio [OR], 7.35; 95% CI, 5.09-10.62) and those aged 35-44 2013s were five times more likely (adjusted OR, 5.22) to report sunburn compared with those aged ≥ 65 2013s. Not having a tertiary education and being in the workforce were also significantly associated with sunburn. Those who had undertaken any physical activity the previous week were more likely to be sunburnt than those who were physically inactive. Sunburn was significantly less likely among people who generally took sun-protective measures in summer. Sunburn was not related to location of residence, socioeconomic disadvantage, skin colour, body weight or current smoking status. CONCLUSIONS: Sunburn remains a public health problem among Queensland residents, especially those under 45 2013s of age. Sun-safe habits reduce sunburn risk, but advice must be integrated with health promotion messages regarding physical activity to reduce the skin cancer burden while maintaining active wellbeing.

Baseline dental plaque activity, mutans streptococci culture, and future caries experience in children.

PURPOSE: The purpose of this study was to evaluate a chairside caries risk assessment protocol utilizing a caries prediction instrument, adenosine triphosphate (ATP) activity in dental plaque, mutans streptococci (MS) culture, and routine dental examination in five- to 10-year-old children at two regional Australian schools with high caries experience. METHODS: Clinical indicators for future caries were assessed at baseline examination using a standardized prediction instrument. Plaque ATP activity was measured directly in relative light units (RLU) using a bioluminescence meter, and MS culture data were recorded. Each child's dentition was examined clinically and radiographically, and caries experience was recorded using enamel white spot lesions and decayed, missing, and filled surfaces for primary and permanent teeth indices. Univariate one-way analysis of variance between selected clinical indicators, ATP activity, MS count at baseline, and future new caries activity was performed, and a generalized linear model for prediction of new caries activity at 24 months was constructed. RESULTS: Future new caries activity was significantly associated with the presence of visible cavitations, reduced saliva flow, and orthodontic appliances at baseline (R(2)=0.2, P<.001). CONCLUSION: Baseline plaque adenosine triphosphate activity and mutans streptococci counts were not significantly associated with caries activity at 24 months.

Large loop excision of transformation zone procedures used in the management of cytological abnormalities of the cervix.

BACKGROUND: National Health and Medical Research Council (NHMRC) guidelines published in 2005 changed the management of cervical squamous intraepithelial lesions. Asymptomatic low-grade abnormalities may be treated conservatively as many regress spontaneously. Cervical changes reflect infection with the human papilloma virus (HPV). Risk factors for acquiring HPV are the same as those for other sexually transmitted infections (STIs). AIMS: To perform a comparison of the Papanicolaou (PAP) smear, histology results of the cervical biopsy and large loop excision of transformation zone (LLETZ) to determine what proportion were over treated, and conversely what proportion would have been under treated in relation to the 2005 NHMRC guidelines. This group of patients was reviewed also for history of STI or concurrent infection. METHODS: Retrospective chart audit of LLETZ procedures and related histology in a population of women under 25 years between 1999 and 2003 presenting to a colposcopy clinic at a regional hospital. RESULTS: Two hundred and fifty-one asymptomatic women underwent LLETZ procedures. Of them, 27.6% reported a history of STI and 9.2% had a positive test result or history of Chlamydia. Based on the 2005 NHMRC guidelines, which require high-grade squamous intraepithelial lesions (HSIL) on PAP or biopsy, 34% of women had no indication for LLETZ. Of these, 65% were over treated having no HSIL on LLETZ histology and 35% would have been under treated. CONCLUSIONS: The 2005 NHMRC guidelines should result in 33.9% fewer LLETZ procedures being performed in the younger age group. This has benefits for their future fertility needs. STI screening would be beneficial in this group when seen at colposcopy clinics, as they have significant rates of prior or current infection.

Cancer incidence and mortality in Indigenous Australians in Queensland, 1997-2006.

OBJECTIVE: To examine cancer incidence and mortality in Indigenous Queenslanders. DESIGN, SETTING AND PATIENTS: Assessment of indirectly standardised incidence and mortality ratios for Indigenous Australians in Queensland diagnosed with cancer from 1997 to 2006, compared with the total Queensland population. MAIN OUTCOME MEASURES: Standardised incidence and mortality ratios. RESULTS: Compared with the total Queensland population, Indigenous Queenslanders had a lower overall incidence of cancer (standardised incidence ratio, 0.79; 95% CI, 0.75-0.82), but a higher incidence of some of the more fatal cancer types. Overall cancer mortality was higher (standardised mortality ratio, 1.36; 95% CI, 1.28-1.45) and similar to rates for Indigenous people in other Australian states. CONCLUSION: Cancer rates for Indigenous Queenslanders, a mostly urbanised population, are similar to rates for Indigenous Australians mostly living in remote areas.

Prevalence and stability of antibodies to 37 human papillomavirus types--a population-based longitudinal study.

Information about serostability of cutaneous HPV types over time is very limited. We investigated seroprevalence and serostability of 37 different HPV types over 4½ years in an Australian population-based study. Sera and data were analyzed for 390 people who had never been diagnosed with SCC and had blood collected in 1992, 1993 and 1996. Eighty-six percent of participants were seropositive to at least one of the 37 HPV types at baseline. HPV-4 was the type with the highest seroprevalence (41%), followed by HPV-38 and HPV-8 (both 33%). Over 90% of people retained their baseline serostatus during the 4½ year follow-up. Highest serostability was observed for HPV-88 (99.7% stayed seropositive or seronegative), while HPV-65 was least stable with 17% altering their serostatus during follow-up. Seroprevalence to cutaneous HPV types are relatively stable over time, and a single measure can be used as a reasonable marker of long-term antibody status.

Measures of blood loss and red cell transfusion targets for caesarean delivery complicated by placenta praevia.

OBJECTIVE: The objective of this study was to assess the association between transfusion, per cent drop in haemoglobin (Hb), and estimated blood loss during the delivery and the first postoperative week following caesarean delivery for placenta praevia. Clinical data predictive of an objective laboratory test for risk of haemorrhage and the need for transfusion were investigated. Transfusions outside national Guidelines were noted. DESIGN: Retrospective observational study of patients with placenta praevia, who were delivered consecutively by caesarean section at Royal Brisbane and Women's Hospital from 1999 to 2005. SETTING: University-affiliated tertiary hospital. All caesareans were performed by one or more consultant obstetricians, gynaecology oncology surgeons and registrar assistants. RESULTS: Seventy-one (28.9%) of 246 patients with placenta praevia were transfused, with 45 of these receiving three or more red cell units. The antenatal Hb fell by a mean of 20.2% (SD 13.5). The average operative haemorrhage was estimated as 1225 mL (SD 996). No patient or surgical factors were significantly associated with changes in Hb. There was a significant association between per cent fall in antenatal Hb and both transfusion P < 0.001 and estimated loss P = 0.002. After transfusion, the Hb of 19 patients was higher than that recommended by Guidelines. CONCLUSIONS: Whether transfusion is necessary, but not the number of red cell units, can be planned by the effect of haemorrhage on antenatal Hb during delivery by caesarean section complicated by placenta praevia.

Prevalence and stability of antibodies to the BK and JC polyomaviruses: a long-term longitudinal study of Australians.

Serology has been used to indicate past infection by the human polyomaviruses BK virus (BKV) and JC virus (JCV), because the site of primary infection is not established fully. Little is known about BKV and JCV antibody stability over time. We investigated BKV and JCV seroprevalence and antibody stability over time in an Australian population-based study. Serum was collected from 458 adults participating in a longitudinal skin cancer study in Queensland in 1992, 1993 and 1996, and 117 people had a fourth sample collected in 2003. Serum samples were analysed for BKV and JCV VP1 antibodies by multiplex detection using the Luminex platform. The seroprevalence for BKV and JCV over 4.5 years was 97 and 63 %, respectively. The BKV seroprevalence was 99 % in 25-60-year-olds, and 94 % in people older than 60 years. JCV seroprevalence was around 60 % in people younger than 50 years, 68 % in people 50-70 years of age and 64 % in people older than 70 years. BKV seroprevalence was very stable over 11 years, with 96 % of people staying seropositive and 2 % remaining seronegative. JCV antibody status over time was less stable; 57 % of participants remained seropositive and 31 % seronegative. The same proportion of people (4 % each) seroconverted, seroreverted or had fluctuating JCV antibody levels. These results confirm the previously believed stability of polyomavirus antibodies, with BKV antibodies being highly stable and JCV antibodies moderately so. Thus, a single measure can be used as a reasonable indicator of long-term antibody status in epidemiological studies aiming to understand associations between polyomaviruses and disease.

Reproducibility of food and nutrient intake estimates using a semi-quantitative FFQ in Australian adults.

OBJECTIVE: To assess the reproducibility of a 135-item self-administered semi-quantitative FFQ. DESIGN: Control subjects who had previously completed an FFQ relating to usual dietary intake in a nationwide case-control study of cancer between November 2003 and April 2004 were randomly selected, re-contacted, and invited to complete the same FFQ a second time approximately one year later (between January and April 2005). Agreement between the two FFQ was compared using weighted kappa statistics and intraclass correlation coefficients (ICC) for food groups and nutrients. Summary questions, included in the FFQ, were used to assess overall intakes of vegetables, fruits and meat. SETTING: General community in Australia. SUBJECTS: One hundred men and women aged 22-79 years, randomly selected from the previous control population. RESULTS: The weighted kappa and ICC measures of agreement for food groups were moderate to substantial for seventeen of the eighteen food groups. For nutrients, weighted kappa ranged from 0.44 for starch to 0.83 for alcohol while ICC ranged from 0.51 to 0.91 for the same nutrients. Estimates of meat, fruit and vegetable intake using summary questions were similar for both survey periods, but were significantly lower than estimates from summed individual food items. CONCLUSIONS: The FFQ produced reproducible results and is reasonable in assessing the usual intake of various foods and nutrients among an Australian adult population.

Review of patient-reported type 2 diabetes service quality.

A critical review was conducted of the literature from 1960 to June 2005 on service quality in type 2 diabetes. The review demonstrated that improving service quality may improve the outcomes for people with type 2 diabetes. The potential service quality factors from the perspective of people with type 2 diabetes were: timeliness, confidentiality, continuity, dignity, communication, access, education, cost, amenities and autonomy.

Clinical outcomes of Queensland children with cystic fibrosis: a comparison between tertiary centre and outreach services.

OBJECTIVE: To evaluate and compare the clinical outcomes of children with cystic fibrosis (CF) managed primarily at a tertiary cystic fibrosis centre (CFC) with those treated at regional centres by local health care professionals and the cystic fibrosis outreach service (CFOS). DESIGN, SETTING AND PATIENTS: Retrospective study of 273 children with CF born between 19 October 1982 and 19 February 2002 and with clinical data available between 1 January 2000 and 31 December 2002. Patients were grouped into CFC (n = 131) or CFOS (n = 142), with CFOS then further categorised into three groups depending on the level of care they received. MAIN OUTCOME MEASURES: Pulmonary function, Pseudomonas aeruginosa status, height and weight z scores, and hospital admission rates. RESULTS: There were no significant differences in pulmonary function, P. aeruginosa status, or height and weight z scores between children managed by CFC or by CFOS. Children receiving more care at the CFC (level of care [LOC] 1 and 2) were more likely to have multiple hospital admissions than children receiving more care in regional areas (LOC 3 and 4) (P < 0.001). CONCLUSION: The CFOS model provides effective delivery of specialised multidisciplinary care to children and adolescents living in rural and regional Queensland.

Abnormalities of the PTH-vitamin D axis and bone turnover markers in children, adolescents and adults with cystic fibrosis: comparison with healthy controls.

Abnormalities of calcium and vitamin D metabolism in cystic fibrosis (CF) are well documented. We tested the hypothesis that alterations in calcium metabolism are related to vitamin D deficiency, and that bone resorption is increased relative to accretion in patients with CF. Calcitropic hormones, electrolytes, osteocalcin (OC) and bone alkaline phosphatase (BAP), (markers of bone mineralisation), urinary deoxypyridinoline [total (t) Dpd, a marker of bone resorption] and lumbar spine bone mineral density (LS BMD), expressed as a z-score, were measured in 149 (81 M) CF and 141 (61 M) control children aged 5.3-10.99 years, adolescents aged 11-17.99 years and adults aged 18-55.9 years. Data were analysed by multiple regression to adjust for age. In patients, FEV(1)% predicted and CRP (as disease severity markers), genotype and pancreatic status (PS) were recorded. The distribution of PTH differed between groups ( P<0.0001), with CF levels both below and above the control range. 25OH vitamin D (25OHD) was not different in control and CF subjects ( P=0.06). Active hormonal vitamin D (1,25(OH)(2)D) was lower in the CF group ( P<0.0001), not explained by 25OHD or disease severity, as was serum magnesium ( P<0.0001). OC was decreased in CF adults ( P=0.004), and tDpd increased in CF adolescents ( P=0.003) and adults ( P=0.03). The ratio of OC to tDpd (a measure of bone coupling) was similar in CF and control children, but decreased in CF adolescents ( P=0.04) and adults ( P=0.02), suggesting decreased overall bone accrual in CF adolescents and uncoupling of bone balance in adults. 1,25(OH)2D was weakly correlated with OC in CF children ( r=0.43, P=0.01), and with tDpd in CF and control adolescents ( r=0.33, P=0.05 and r=0.36, P=0.02, respectively); thus there was limited evidence of association of calcitropic hormones, which had an abnormal pattern in all age groups, with bone turnover. There was no association between calcitropic hormones or bone turnover markers and LS BMD z-score. Despite vitamin D sufficiency, abnormalities of calcium metabolism and bone turnover markers were still apparent and bone accretion was decreased relative to resorption in the CF adolescent and adult groups. These changes were not fully explained by disease severity or genotype, but are consistent with reports of decreased BMD and unique bone histomorphometry in older subjects with CF.