Cardiac procedures in ST-segment-elevation myocardial infarction - the influence of age, geography and Aboriginality.

BACKGROUND: Timely restoration of bloodflow acute ST-segment elevation myocardial infarction (STEMI) reduces myocardial damage and improves prognosis. The objective of this study was describe the association of demographic factors with hospitalisation rates for STEMI and time to angiography, Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Graft (CABG) in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia. METHODS: This was an observational cohort study using linked population health data. We used linked records of NSW and the ACT hospitalisations and the Australian Government Medicare Benefits Schedule (MBS) for persons aged 35 and over hospitalised with STEMI in the period 1 July 2010 to 30 June 2014. Survival analysis was used to determine the time between STEMI admission and angiography, PCI and CABG, with a competing risk of death without cardiac procedure. RESULTS: Of 13,117 STEMI hospitalisations, 71% were among males; 55% were 65-plus years; 64% lived in major cities, and 2.6% were Aboriginal people. STEMI hospitalisation occurred at a younger age in males than females. Angiography and PCI rates decreased with age: angiography 69% vs 42% and PCI 60% vs 34% on day 0 for ages 35-44 and 75-plus respectively. Lower angiography and PCI rates and higher CABG rates were observed outside major cities. Aboriginal people with STEMI were younger and more likely to live outside a major city. Angiography, PCI and CABG rates were similar for Aboriginal and non-Aboriginal people of the same age and remoteness area. CONCLUSIONS: There is a need to improve access to definitive revascularisation for STEMI among appropriately selected older patients and in regional areas. Aboriginal people with STEMI, as a population, are disproportionately affected by access to definitive revascularisation outside major cities. Improving access to timely definitive revascularisation in regional areas may assist in closing the gap in cardiovascular outcomes between Aboriginal and non-Aboriginal people.

Inter-hospital variations in labor induction and outcomes for nullipara: an Australian population-based linkage study.

INTRODUCTION: This study aimed to describe variation in inter-hospital induction of labor (IOL) rates, determine whether variation is explained by individual and hospital factors and examine birth outcomes. MATERIAL AND METHODS: Nullipara at term with a singleton cephalic birth were identified using linked hospital discharge and birth data for 66 hospitals in New South Wales, Australia, 2010-2011. Random effects multilevel logistic regression models were fitted for early term, full term, and late term births, adjusting for individual and hospital factors. Hospital intrapartum cesarean rates, and severe maternal and neonatal morbidity outcomes were determined according to hospital IOL rate. RESULTS: Of 69 549 nullipara, 24 673 (35%) had an IOL. For early term births, adjusted hospital IOL (aIOL) rates varied (3.3-13.9%), with 11 of 66 (17%) hospitals having aIOL rates significantly different from the average aIOL rate. For births at full term, the hospital aIOL rates varied (10.6-32.6%), with 29 hospitals (44%) having aIOL rates significantly different from the average aIOL rate. For late term births, the hospital aIOL rates varied (45.1-67.5%), with 11 hospitals (17%) having aIOL rates significantly different from the overall average aIOL rate for women with late term births. There was generally no relationship between higher or lower hospital IOL rates and intrapartum cesarean section rates, or maternal or neonatal adverse outcomes. CONCLUSIONS: Inter-hospital IOL rates for nullipara with a singleton cephalic term birth had high unexplained variation, with no clear association with intrapartum cesarean section rates, or maternal or neonatal adverse outcomes.

Quantifying under-reporting of pathology tests in Medical Benefits Schedule claims data.

OBJECTIVE: We investigated the completeness of recording of pathology tests in Australian Medical Benefits Schedule (MBS) claims data, using the example of the prostate-specific antigen (PSA) test. With some exceptions, MBS claims data records only the three most expensive pathology items in an episode of care, and this practice ('episode coning') means that pathology tests can be under-recorded. METHODS: The analysis used MBS data for male participants in the 45 and Up Study. The number and cost of items in each episode of care were used to determine whether an episode contained a PSA screening test (Item 66655), or could have lacked a record of this item because of episode coning. RESULTS: MBS data for 1070392 episodes involving a request for a pathology test for 118074 men were analysed. Of these episodes, 11% contained a request for a PSA test; a further 7.5% may have been missing a PSA request that was not recorded because of episode coning. CONCLUSIONS: It is important to consider under-reporting of pathology tests as a result of episode coning when interpreting MBS claims data. Episode coning creates uncertainty about whether a person has received any given pathology test. The extent of this uncertainty can be estimated by determining the proportion of episodes in which the test may have been performed but was not recorded due to episode coning.

SMARTERscreen protocol: a three-arm cluster randomised controlled trial of patient SMS messaging in general practice to increase participation in the Australian National Bowel Cancer Screening Program.

BACKGROUND: Australia persistently has one of the highest rates of colorectal cancer (CRC) in the world. Australia's National Bowel Cancer Screening Program (NBCSP) sends a biennial Faecal Immunochemical Test (FIT)-the 'NBCSP kit'-to everyone eligible for the programme between 50 and 74 years old; however, participation in the programme is low, especially in the 50- to 60-year-old age group. Our previous efficacy trial ('SMARTscreen') demonstrated an absolute increase in uptake of 16.5% (95% confidence interval = 2.02-30.9%) for people sent an SMS with motivational and instructional videos, from their general practice prior to receiving their NBCSP kit, compared to those receiving usual care. Building on the strengths of the SMARTscreen trial and addressing limitations, the 'SMARTERscreen' trial will test the effect on participation in the NBCSP of sending either an SMS only or an SMS with online video material to general practice patients due to receive their NBCSP compared to 'usual care'. METHODS: SMARTERscreen is a three-arm stratified cluster randomised controlled trial involving 63 general practices in two states in Australia. Eligible patients are patients who are aged 49-60 years and due to receive their NBCSP kit within the next 2 weeks during the intervention period. General practices will be equally randomised to three trial arms (21:21:21, estimated average 260 patients/practice). The two interventions include (i) an SMS with an encouraging message from their general practice or (ii) the same SMS with weblinks to additional motivational and instructional videos. The control arm will receive 'usual care'. Using the intention-to-treat approach, primary analysis will estimate the three pair-wise between-arm differences in the proportion of eligible patients who participate in the NBCSP within 6 months of when their kit is sent, utilising screening data from the Australian National Cancer Screening Register (NCSR). Patient intervention adherence to the interventions will also be evaluated. Findings will be incorporated into the Policy1-Bowel microsimulation model to estimate the long-term health benefits and cost-effectiveness of the interventions. DISCUSSION: SMARTERscreen will provide high-level evidence determining whether an SMS or an SMS with web-based material sent to general practice patients prior to receiving their NBCSP kit increases participation in bowel cancer screening. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000036617. Registered on 13 January 2023. Trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385119&isClinicalTrial=False.

Effects of clock monitoring on electroencephalographic activity: is unconscious movement initiation an artifact of the clock?

Electroencephalographic (EEG) activity was recorded while participants waited to make spontaneous key-press movements (Experiment 1) or waited for tones in a pitch judgment task (Experiment 2). In one condition of each experiment, participants also had to report the position of a spot traveling on a clock at the crucial time point (i.e., when they decided to move or when the tone was presented), mimicking a procedure used to assess the time of conscious awareness of an event of interest. In a second condition, there was no clock or temporal judgment. Average EEG activity preceding key presses was substantially different when participants had to monitor the clock than when they did not. Smaller clock-related differences in average EEG activity were also present preceding tone onsets. The effects of clock monitoring on EEG activity could be responsible for previous reports that movement-related brain activity begins before participants have consciously decided to move (e.g., Libet, Gleason, Wright, & Pearl, 1983).

Electronic gaming as pain distraction.

The current study investigated whether active distraction reduces participants' experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C) water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system) and passive (television) distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants' expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control.

Brain preparation before a voluntary action: evidence against unconscious movement initiation.

Benjamin Libet has argued that electrophysiological signs of cortical movement preparation are present before people report having made a conscious decision to move, and that these signs constitute evidence that voluntary movements are initiated unconsciously. This controversial conclusion depends critically on the assumption that the electrophysiological signs recorded by Libet, Gleason, Wright, and Pearl (1983) are associated only with preparation for movement. We tested that assumption by comparing the electrophysiological signs before a decision to move with signs present before a decision not to move. There was no evidence of stronger electrophysiological signs before a decision to move than before a decision not to move, so these signs clearly are not specific to movement preparation. We conclude that Libet's results do not provide evidence that voluntary movements are initiated unconsciously.

Variation in hospital rates of induction of labour: a population-based record linkage study.

OBJECTIVES: To examine interhospital variation in rates of induction of labour (IOL) to identify potential targets to reduce high rates of practice variation. DESIGN: Population-based record linkage cohort study. SETTING: New South Wales, Australia, 2010-2011. PARTICIPANTS: All women with live births of ≥24 weeks gestation in 72 hospitals. PRIMARY OUTCOME MEASURE: Variation in hospital IOL rates adjusted for differences in case-mix, according to 10 mutually exclusive groups derived from the Robson caesarean section classification; groups were categorised by parity, plurality, fetal presentation, prior caesarean section and gestational age. RESULTS: The overall IOL rate was 26.7% (46,922 of 175,444 maternities were induced), ranging from 9.7% to 41.2% (IQR 21.8-29.8%) between hospitals. Nulliparous and multiparous women at 39-40 weeks gestation with a singleton cephalic birth were the greatest contributors to the overall IOL rate (23.5% and 20.2% of all IOL respectively), and had persisting high unexplained variation after adjustment for case-mix (adjusted hospital IOL rates ranging from 11.8% to 44.9% and 7.1% to 40.5%, respectively). In contrast, there was little variation in interhospital IOL rates among multiparous women with a singleton cephalic birth at ≥41 weeks gestation, women with singleton non-cephalic pregnancies and women with multifetal pregnancies. CONCLUSIONS: 7 of the 10 groups showed high or moderate unexplained variation in interhospital IOL rates, most pronounced for women at 39-40 weeks gestation with a singleton cephalic birth. Outcomes associated with divergent practice require determination, which may guide strategies to reduce practice variation.

Physical health correlates of overprediction of physical discomfort during exercise.

This study sought to determine if overprediction of physical discomfort prior to and following exercise was related to a number of self-report and objective measures of physical health status in a general population sample. Cross-sectional findings indicated a significant and specific relation between patterns of discomfort overprediction (vs under- or accurate prediction) and negative self-reported health status and attitudes to exercise, lower levels of physical activity, as well as poorer scores for resting heart rate, cardiorespiratory fitness and body mass index (but not waist:hip ratio). Females were more likely to overpredict discomfort, were less active and had poorer physical health than males. The potential usefulness of the prediction match-mismatch paradigm for studying exercise-related appraisal processes as proximal determinants of physical activity are discussed. Information obtained from such studies could prove useful in public health education campaigns aimed at increasing levels of physical activity in the general population, particularly among the less active.

Imprisonment of opioid-dependent people in New South Wales, Australia, 2000­2012: a retrospective linkage study.

There are few data about the incarceration of opioid-dependent people involving large representative cohorts. We aimed to determine the prevalence and duration of incarceration in a large cohort of opioid-dependent people in Australia using data linkage methods, and estimate the costs associated with their incarceration.Method: Retrospective linkage study of all entrants to opioid substitution therapy (OST) for the treatment of opioid dependence in NSW, 1985­2010, with data on incarceration, 2000-2012. The number and duration of incarcerations were calculated. The average daily cost of incarceration was applied to days of incarceration in the cohort.Results: Among 47,196 opioid-dependent people, 37% (43% of men and 24% of women) had at least one episode of incarceration lasting one or more days. Men had a median of three(ranging between 1-47) incarcerations, and women, two (1-35). Indigenous men spent 23% of follow-up time incarcerated, compared with 8% for non-Indigenous men; similarly, Indigenous women spent a substantially greater proportion of time incarcerated than non-Indigenous women (8% vs. 2%). Costs of incarceration of this cohort between 2000 and 2012 totalled nearly AUD $3 billion.Conclusions: This is the first study to examine incarceration of opioid-dependent people across an entire population of such users. Our findings suggest that a substantial minority of opioid-dependent people experience incarceration, usually on multiple occasions and at significant cost. Treatment for opioid dependence, inside and outside prisons, may help reduce incarceration of this cohort.

Engagement with the criminal justice system among opioid-dependent people: a retrospective cohort study.

AIMS: Studies of offending among people who use drugs typically focus upon small and potentially unrepresentative samples. We examined an entire population of opioid-dependent clients' contact with the criminal justice system to develop more accurate population-wide measures of offending among opioid-dependent people in Australia. DESIGN: Retrospective data linkage study. SETTING: All entrants to opioid substitution therapy (OST) for opioid dependence in New South Wales, Australia, between 1985 and 2010, with data on court appearances from 1 December 1993 to 31 March 2011. PARTICIPANTS: All 48 069 valid cohort members who received OST between 1985 and 2010. MEASUREMENTS: Person-years (PY) of observation and charge rates for major crime categories estimated by sex, age and time. FINDINGS: A total of 638 545 charges were laid against cohort members between 1993 and 2011. Eight in 10 males (79.7%) and 67.9% of females had at least one charge; rates were 94.15 per 100 PY [95% confidence interval (CI) = 93.89-94.41] among males, and 53.19 per 100 PY (95% CI = 52.91-53.46) among females, and highest at 15-19 years [175.74/100 PY males (95% CI = 174.45-177.03), 75.60/100 PY females (95% CI = 74.46-76.76)] and 20-24 years [144.61/100 PY males (95% CI = 143.70-145.53), 84.50/100 PY females (95% CI = 83.53-85.48)]. The most frequent charges were theft (24.5% of charges), traffic/vehicle (16.3%), offences against justice (10.5%), illicit drug (10.0%), intentional injury (9.9%) and public order offences (8.9%). Overall, 20.8% of the cohort accounted for 67.4% of charges. The most frequently appearing 5.6% of the cohort accounted for 24.3% of costs ($75.5 million). CONCLUSIONS: Among opioid-dependent people in Australia, a minority account for the majority of the criminal justice contact and levels of offending are not consistent over time, sex or age.

Beliefs of New Zealand doctors about integrative medicine for cancer treatment.

UNLABELLED: AIMS. This study aimed to give an up-to-date description of the views and knowledge that health professionals in New Zealand (NZ) have about complementary and alternative medicine (CAM) and its use in the context of integrative medicine. STUDY DESIGN: A self-administered questionnaire. METHODS: Doctors in the Otago region of New Zealand (n = 235 out of 395, 59% response rate) answered questions addressing attitudes toward the principle of integrative medicine, attitudes indigenous Ma-ori holistic views of health, and attitudes about CAM. Information on physician demographics was also gathered. RESULTS: Almost all doctors (95%) agreed that they should address all aspects of a patient's health, whereas around 60% agreed that CAM can be integrated into a treatment regime to provide the best care for a patient. Most (93%) agreed that in a NZ context, it is important to be aware of Ma-ori holistic views of health. Doctors had many concerns about CAM, and only 26% personally used any CAM therapies themselves. However, many doctors wanted to learn more about CAM (58%) and Ma-ori holistic views of health (62%). Doctors who believed that they "knew enough" about CAM were more likely to ask about it and to recommend it to patients. CONCLUSION: Integrative medicine is increasingly being accepted in medical practice, although many doctors still do not agree with the use of CAM. There is a need for increased patient-doctor discussions of CAM use. Doctors' lack of knowledge about CAM may be a barrier to communication and should be addressed with specific medical training.

Defensive practice in mental health.

AIM: This study aimed to assess the extent of defensive clinical practice by psychiatrists and psychiatric nurses in a New Zealand Mental Health Service. METHOD: An anonymous questionnaire survey, addressing perceptions of a variety of defensive practices, was sent to all psychiatrists and psychiatric nurses working in acute clinical settings in the publically funded mental health service in Dunedin, New Zealand. RESULTS: Defensive practice is perceived as widespread in psychiatric settings. In particular, practices such as questioning patients about their safety, admissions to hospital, and delayed discharge from hospital were often perceived as occurring for defensive purposes. Psychiatric nurses were more likely than psychiatrists to perceive such practices as defensive. CONCLUSION: Defensive practice is common in mental health. This is despite New Zealand's no-fault compensation scheme, and so presumably results from concerns other than the risk of financial liability. There may be particular pressures in mental health to practice defensively.

Perceptions of New Zealand adults about reducing their risk of getting cancer.

AIM: To assess perceptions about potentially modifiable causes of cancer. METHODS: An anonymous telephone questionnaire administered to a sample, 20 years and older, randomly selected from telephone directory listings. RESULTS: Nearly 90% of 438 respondents (68% participation) considered that there were things which people could do to reduce cancer risk. Unprompted, almost two-thirds mentioned nutrition, and more than half suggested "not smoking." Other suggestions included being physically active, and protection from excessive sun exposure. Two-thirds believed they could reduce their own risk, and by interview end this increased significantly to 72%. Half named items which people could consume to reduce risk: more vegetables, fruit or water; less alcohol, fatty foods, and meat. Greatest awareness was of risks from sunburn, secondhand tobacco smoke, sunlamps, eating animal fat, and being overweight, and of the protective effects of eating grains, fruit, and vegetables. Many considered stress, cellular phones, and genetically modified foods as risks, and vitamin and mineral supplements as protective. Few indicated awareness of risks from hepatitis B or alcohol. CONCLUSIONS: Greater public awareness about avoiding tobacco smoking and excessive sun exposure suggests gains from past efforts. To achieve similar awareness for other cancer prevention strategies, and to correct misconceptions, comparable resources and efforts are likely to be required.

Perceptions of New Zealand adults about complementary and alternative therapies for cancer treatment.

AIM: To study perceptions regarding complementary and alternative medicine (CAM) treatments for cancer among adult New Zealanders. METHODS: An anonymous telephone questionnaire that included questions to explore perceptions about CAM and cancer treatment was administered to a randomly selected sample of New Zealanders, 20 years and older. RESULTS: A total of 438 New Zealand adults participated in the survey, out of 689 eligible contacts (68% participation). Less than one-third (28%) agreed with the statement alternative therapy for cancer has an equal or better chance of curing cancer as medical treatment, 34% disagreed, and 38% said they did not know. Most (63%) felt that complementary therapies could be beneficial to people who were also receiving conventional cancer treatment, although only 36% could name one or more such therapies. One-third (32%) said that alternative therapies could be used instead of conventional cancer treatments, but only 16% of the sample could name any alternative therapies. The CAM therapies named most often were nutrition (vitamin and mineral supplements, herbs, and diets) and psychosocial therapies (including positive thinking, spiritual therapies, and relaxation). CONCLUSIONS: There seems to be little consensus about the efficacy of CAM therapies for cancer. New Zealanders may lack information about CAM, or may be withholding judgment because of contradictory messages.

Adults' perceptions of the causes and primary prevention of common fatal cancers in New Zealand.

AIMS: To assess population perceptions of the causes and primary prevention of common fatal cancers, and to help inform the New Zealand Cancer Control Strategy. METHODS: A national telephone survey obtained perceptions from a random population sample, 20 years or older, identified from telephone directory listings, supplemented with self-identified Maori from electoral rolls. Quotas were set to recruit population proportions consistent with 1996 Census distributions. RESULTS: The 438 respondents (64% participation) matched 1996 Census distributions for age, sex and ethnicity, but were socioeconomically advantaged. Among women, breast, cervical and lung cancer were most salient; among men, prostate, lung and bowel cancer - partially congruent with population statistics. There was high unprompted awareness that tobacco smoke and sun exposure affect lung cancer and skin cancer risk, respectively, but less awareness of potential protective strategies for other cancers. CONCLUSIONS: Perceptions of cancer risk and prevention are affected by high-profile programmes. Cancer prevention activities should reflect known risks and the potential for prevention. With high incidence and death rates and potentially modifiable risks, bowel cancer deserves greater attention. A comprehensive cancer prevention strategy needs to go beyond raising awareness and the promotion of individual behavioural change to the development of healthy public policies and practices that create supportive environments for health-promoting behaviours.

Cortical movement preparation before and after a conscious decision to move.

The idea that our conscious decisions determine our actions has been challenged by a report suggesting that the brain starts to prepare for a movement before the person concerned has consciously decided to move (Libet, Gleason, Wright, & Pearl, 1983). Libet et al. claimed that their results show that our actions are not consciously initiated. The current article describes two experiments in which we attempted to replicate Libet et al.'s comparison of participants' movement-related brain activity with the reported times of their decisions to move and also the reported times of their decisions of which hand to move. We also looked at the distribution of participants' reports over time to evaluate an alternative explanation of Libet et al.'s (1983) results. Although the Readiness Potential was usually present before all of the decisions to move, consistent with the findings of Keller and Heckhausen (1990) and Libet et al. (1983), we found that many reported decision times were before the onset of the Lateralized Readiness Potential, which measures hand-specific movement preparation. The latter finding is consistent with the conclusion that the LRP always started after the conscious decision to move. We conclude that even though activity related to movement anticipation may be present before a conscious decision to move, the cortical preparation necessary for the movement to happen immediately may not start until after the conscious decision to move.