Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review.

Little is known about the methods and outcomes of patient-reported outcome measure (PROM) use among high-risk medical device registries. The objective of this scoping review was to assess the utility and predictive ability of PROMs in high-risk medical device registries. We searched Ovid Medline, Embase, APA PsychINFO, Cochrane Library, and Scopus databases for published literature. After searching, 4323 titles and abstracts were screened, and 262 full texts were assessed for their eligibility. Seventy-six papers from across orthopedic (n = 64), cardiac (n = 10), penile (n = 1), and hernia mesh (n = 1) device registries were identified. Studies predominantly used PROMs as an outcome measure when comparing cohorts or surgical approaches (n = 45) or to compare time points (n = 13) including pre- and postintervention. Fifteen papers considered the predictive ability of PROMs. Of these, 8 treated PROMs as an outcome, 5 treated PROMs as a risk factor through regression analysis, and 2 papers treated PROMs as both a risk factor and as an outcome. One paper described PROMs to study implant survival. To advance methods of PROM integration into clinical decision-making for medical devices, an understanding of their use in high-risk device registries is needed. This scoping review found that there is a paucity of studies using PROMs to predict long-term patient and clinical outcomes in high-risk medical device registries. Determination as to why PROMs are rarely used for predictive purposes in long-term data collection is needed if PROM data are to be considered suitable as real-world evidence for high-risk device regulatory purposes, as well as to support clinical decision-making.

Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study.

Background: Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods: We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category. Results: We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions: We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.

Machine Learning Techniques to Predict Timeliness of Care among Lung Cancer Patients.

Delays in the assessment, management, and treatment of lung cancer patients may adversely impact prognosis and survival. This study is the first to use machine learning techniques to predict the quality and timeliness of care among lung cancer patients, utilising data from the Victorian Lung Cancer Registry (VLCR) between 2011 and 2022, in Victoria, Australia. Predictor variables included demographic, clinical, hospital, and geographical socio-economic indices. Machine learning methods such as random forests, k-nearest neighbour, neural networks, and support vector machines were implemented and evaluated using 20% out-of-sample cross validations via the area under the curve (AUC). Optimal model parameters were selected based on 10-fold cross validation. There were 11,602 patients included in the analysis. Evaluated quality indicators included, primarily, overall proportion achieving "time from referral date to diagnosis date ≤ 28 days" and proportion achieving "time from diagnosis date to first treatment date (any intent) ≤ 14 days". Results showed that the support vector machine learning methods performed well, followed by nearest neighbour, based on out-of-sample AUCs of 0.89 (in-sample = 0.99) and 0.85 (in-sample = 0.99) for the first indicator, respectively. These models can be implemented in the registry databases to help healthcare workers identify patients who may not meet these indicators prospectively and enable timely interventions.

Examining MEmory Training for Recovery-Adolescent among Afghan adolescent boys: a pilot randomised controlled trial.

Objective: To conduct a pilot randomised controlled trial examining the feasibility, acceptability and efficacy of MEmory Training for Recovery-Adolescent (METRA) in improving psychological symptoms among Afghan adolescent boys following a terrorist attack.Method: A pilot randomised controlled trial compared METRA to a Control Group, with a three-month follow-up. The study occurred in Kabul (June-November 2022). Fifty-eight boys aged 14-19 years (Mage = 16.70, SD = 1.26) with heightened posttraumatic stress disorder (PTSD) symptoms were recruited through a local school that had recently experienced a terrorist attack. Participants were randomised 1:1 to receive METRA (n = 28) (10 session group-intervention) or Control (n = 30) (10 group-sessions of study skills). Primary outcomes were self-reported PTSD symptoms at post-intervention. Secondary outcomes included self-reported anxiety, depression, Afghan-cultural distress symptoms and psychiatric difficulties.Results: There were challenges in youth participation related to security and competing education demands. For those who did complete METRA, METRA was deemed feasible and acceptable. Following the intent-to-treat principle, linear mixed effects models found at posttreatment the METRA group had a 20.89-point (95%CI -30.66, -11.11) decrease in PTSD symptoms, while the Control Group had a 1.42-point (95%CI -8.11, 5.27) decrease, with the group over time interaction being significant (p < .001). METRA participants had significantly greater reductions in depression, anxiety, Afghan-cultural distress symptoms and psychiatric difficulties than did Controls. All gains were maintained at three-month follow-up.Conclusions: With some modifications, METRA appears a feasible intervention for adolescent boys in humanitarian contexts in the aftermath of a terrorist attack.

Very few adolescents in Afghanistan receive evidence-based psychological interventions.MEmory Training for Recovery-Adolescents was associated with significant reductions in psychological symptoms.With some modifications, MEmory Training for Recovery-Adolescents appears a feasible intervention for adolescent boys in humanitarian contexts in the aftermath of a terrorist attack.

Evaluations of statistical methods for outlier detection when benchmarking in clinical registries: a systematic review.

OBJECTIVES: Benchmarking is common in clinical registries to support the improvement of health outcomes by identifying underperforming clinician or health service providers. Despite the rise in clinical registries and interest in publicly reporting benchmarking results, appropriate methods for benchmarking and outlier detection within clinical registries are not well established, and the current application of methods is inconsistent. The aim of this review was to determine the current statistical methods of outlier detection that have been evaluated in the context of clinical registry benchmarking. DESIGN: A systematic search for studies evaluating the performance of methods to detect outliers when benchmarking in clinical registries was conducted in five databases: EMBASE, ProQuest, Scopus, Web of Science and Google Scholar. A modified healthcare modelling evaluation tool was used to assess quality; data extracted from each study were summarised and presented in a narrative synthesis. RESULTS: Nineteen studies evaluating a variety of statistical methods in 20 clinical registries were included. The majority of studies conducted application studies comparing outliers without statistical performance assessment (79%), while only few studies used simulations to conduct more rigorous evaluations (21%). A common comparison was between random effects and fixed effects regression, which provided mixed results. Registry population coverage, provider case volume minimum and missing data handling were all poorly reported. CONCLUSIONS: The optimal methods for detecting outliers when benchmarking clinical registry data remains unclear, and the use of different models may provide vastly different results. Further research is needed to address the unresolved methodological considerations and evaluate methods across a range of registry conditions. PROSPERO REGISTRATION NUMBER: CRD42022296520.

A Systematic Review of Areal Units and Adjacency Used in Bayesian Spatial and Spatio-Temporal Conditional Autoregressive Models in Health Research.

Advancements in Bayesian spatial and spatio-temporal modelling have been observed in recent years. Despite this, there are unresolved issues about the choice of appropriate spatial unit and adjacency matrix in disease mapping. There is limited systematic review evidence on this topic. This review aimed to address these problems. We searched seven databases to find published articles on this topic. A modified quality assessment tool was used to assess the quality of studies. A total of 52 studies were included, of which 26 (50.0%) were on infectious diseases, 10 (19.2%) on chronic diseases, 8 (15.5%) on maternal and child health, and 8 (15.5%) on other health-related outcomes. Only 6 studies reported the reasons for using the specified spatial unit, 8 (15.3%) studies conducted sensitivity analysis for prior selection, and 39 (75%) of the studies used Queen contiguity adjacency. This review highlights existing variation and limitations in the specification of Bayesian spatial and spatio-temporal models used in health research. We found that majority of the studies failed to report the rationale for the choice of spatial units, perform sensitivity analyses on the priors, or evaluate the choice of neighbourhood adjacency, all of which can potentially affect findings in their studies.

Normative cut-offs for polycystic ovary syndrome diagnostic features in adolescents using cluster analysis.

OBJECTIVE: The diagnosis of polycystic ovary syndrome (PCOS) remains challenging with international guidelines prioritising accurate cut-offs for individual diagnostic features. These diagnostic cut-offs are currently based on arbitrary percentiles, often from poorly characterised cohorts, and are dependent on variable laboratory ranges defined by assay manufacturers, limiting diagnostic accuracy. Cluster analysis is the recommended approach for defining normative cut-offs within populations for clinical syndromes. Few PCOS adult studies have applied cluster analysis, with no studies in adolescents. We aimed to define normative cut-offs for individual PCOS diagnostic features in a community-based population of adolescents using cluster analysis. DESIGN: This analysis utilised data from the Menstruation in Teenagers Study, a subgroup of the Raine Study, which is a population based prospective cohort of 244 adolescents whose mean age at PCOS assessment was 15.2 years. METHODS: K-means cluster analysis and receiver operating characteristics curves were used to define normative cut-offs for modified Ferriman-Gallwey (mFG) score, free testosterone (free T), free androgen index (FAI), and menstrual cycle length. RESULTS: Normative cut-offs for mFG, free T, FAI, and menstrual cycle lengths were 1.0, 23.4 pmol/L, 3.6, and 29 days, respectively. These corresponded to the 65th, 71st, 70th, and 59th population percentiles, respectively. CONCLUSION: In this novel study, we define the normative diagnostic criteria cut-offs in this unselected adolescent population and show that these cut-offs correspond to lower percentiles than conventional cut-offs. These findings highlight the pertinent need to re-define PCOS diagnostic cut-offs in adolescents. Validation is required in larger, multi-ethnic, and well-characterised adolescent cohorts.

A Systematic Review of Joint Spatial and Spatiotemporal Models in Health Research.

With the advancement of spatial analysis approaches, methodological research addressing the technical and statistical issues related to joint spatial and spatiotemporal models has increased. Despite the benefits of spatial modelling of several interrelated outcomes simultaneously, there has been no published systematic review on this topic, specifically when such models would be useful. This systematic review therefore aimed at reviewing health research published using joint spatial and spatiotemporal models. A systematic search of published studies that applied joint spatial and spatiotemporal models was performed using six electronic databases without geographic restriction. A search with the developed search terms yielded 4077 studies, from which 43 studies were included for the systematic review, including 15 studies focused on infectious diseases and 11 on cancer. Most of the studies (81.40%) were performed based on the Bayesian framework. Different joint spatial and spatiotemporal models were applied based on the nature of the data, population size, the incidence of outcomes, and assumptions. This review found that when the outcome is rare or the population is small, joint spatial and spatiotemporal models provide better performance by borrowing strength from related health outcomes which have a higher prevalence. A framework for the design, analysis, and reporting of such studies is also needed.

Modeling the effect of diet and physical activity on body mass index in prepregnant and postpartum women.

OBJECTIVES: This study aimed to assess, using simulation modeling, the theoretical effect of key diet and physical activity (PA) modification scenarios could have on body mass index (BMI) in prepregnant and postpartum women. METHODS: Simulation modeling using data from the 2011 to 2012 National Nutrition and Physical Activity Survey was performed for a subsample of prepregnant and postpartum women. The regression coefficients for each diet and PA component from multivariable linear regression equations for BMI were used to calculate a predicted BMI. Scenario modeling using a moderation approach was applied to targeted diet and PA components for the entire sample and subgroups of populations of women who failed to meet dietary and PA recommendations and among the lowest socioeconomic groups. RESULTS: In prepregnancy and postpartum scenarios, respectively, increasing whole grains by 2 to 3 servings/d reduced BMI by 1.16 and 0.85 kg/m2. For postpartum women, BMI was reduced by 0.28 kg/m2 for every 5-g/d increase in fiber intake. A 480- and 540-min/wk increase in PA resulted in average BMI reductions of 0.95 and 1.19 kg/m2 in prepregnant and postpartum women, respectively. A similar pattern of theoretical reductions in BMI was observed with increased whole grains, fiber, and PA among the most disadvantaged socioeconomic groups of women. CONCLUSIONS: Increasing intake of whole grains by 2 to 3 servings/d could result in reductions in BMI of 1.16 and 0.85 kg/m2, and a 480- and 540-min/wk increase in PA could result in BMI reduction of 0.95 and 1.19 kg/m2 in prepregnant and postpartum women, respectively. This provides an evidence base to guide tailored nutrition messaging for obesity prevention efforts in reproductive age women.

Effect of the Memory Training for Recovery-Adolescent Intervention vs Treatment as Usual on Psychiatric Symptoms Among Adolescent Girls in Afghanistan: A Randomized Clinical Trial.

Importance: Adolescents who experience conflict in humanitarian contexts often have high levels of psychiatric distress but rarely have access to evidence-based interventions. Objective: To investigate the efficacy of Memory Training for Recovery-Adolescent (METRA) intervention in improving psychiatric symptoms among adolescent girls in Afghanistan. Design, Setting, and Participants: This randomized clinical trial included girls and young women aged 11 to 19 years with heightened psychiatric distress living in Kabul, Afghanistan, and was conducted as a parallel-group trial comparing METRA with treatment as usual (TAU), with a 3-month follow-up. Participants were randomized 2:1 to receive either METRA or TAU. The study occurred between November 2021 and March 2022 in Kabul. An intention-to-treat approach was used. Interventions: Participants assigned to METRA received a 10-session group-intervention comprised of 2 modules (module 1: memory specificity; module 2: trauma writing). The TAU group received 10 group adolescent health sessions. Interventions were delivered over 2 weeks. Main Outcomes and Measures: Primary outcome measures were self-reported posttraumatic stress disorder (PTSD) and depression symptoms after the intervention. Secondary outcomes were self-reported measures of anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties. Assessments occurred at baseline, after modules 1 and 2, and at 3 months after treatment. Results: The 125 participants had a mean (SD) age of 15.96 (1.97) years. Overall sample size for primary analyses included 80 adolescents in the METRA group and 45 adolescents in TAU. Following the intention-to-treat principle, generalized estimating equations found that the METRA group had a 17.64-point decrease (95% CI, -20.38 to -14.91 points) in PTSD symptoms and a 6.73-point decrease (95% CI, -8.50 to -4.95 points) in depression symptoms, while the TAU group had a 3.34-point decrease (95% CI, -6.05 to -0.62 points) in PTSD symptoms and a 0.66-point increase (95% CI, -0.70 to 2.01 points) in depression symptoms, with the group × time interactions being significant (all P < .001). METRA participants had significantly greater reductions in anxiety, Afghan-cultural distress symptoms, and psychiatric difficulties than TAU participants. All improvements were maintained at 3-month follow-up. Dropout in the METRA group was 22.5% (18 participants) vs 8.9% for TAU (4 participants). Conclusions and Relevance: In this randomized clinical trial, those in the METRA group had significantly greater improvements in psychiatric symptoms relative to those in the TAU group. METRA appeared to be a feasible and effective intervention for adolescents in humanitarian contexts. Trial Registration: anzctr.org.au Identifier: ACTRN12621001160820.

Long term survival and disease burden from out-of-hospital cardiac arrest in Singapore: a population-based cohort study.

Background: Understanding the long-term outcomes and disability-adjusted life years (DALY) after out-of-hospital cardiac arrest (OHCA) is important to understand the overall health and disease burden of OHCA respectively, but data in Asia remains limited. We aimed to quantify long-term survival and the annual disease burden of OHCA within a national multi-ethnic Asian cohort. Methods: We conducted an open cohort study linking the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and the Singapore Registry of Births and Deaths from 2010 to 2019. We performed Cox regression, constructed Kaplan-Meier curves, and calculated DALYs and standardised mortality ratios (SMR) for each year of follow-up. Results: We analysed 802 cases. The mean age was 56.0 (SD 17.8). Most were male (631 cases, 78,7%) and of Chinese ethnicity (552 cases, 68.8%). At one year, the SMR was 14.9 (95% CI:12.5-17.8), decreasing to 1.2 (95% CI:0.7-1.8) at three years, and 0.4 (95% CI:0.2-0.8) at five years. Age at arrest (HR:1.03, 95% CI:1.02-1.04, p < 0.001), shockable presenting rhythm (HR:0.75, 95% CI:0.52-0.93, p = 0.015) and CPC category (HR:4.62, 95% CI:3.17-6.75, p < 0.001) were independently associated with mortality. Annual DALYs due to OHCA varied from 304.1 in 2010 to 849.7 in 2015, then 547.1 in 2018. Mean DALYs decreased from 12.162 in 2010 to 3.599 in 2018. Conclusions: OHCA survivors had an increased mortality rate for the first three years which subsequently normalised compared to that of the general population. Annual OHCA disease burden in DALY trended downwards from 2010 to 2018. Improved surveillance and OHCA treatment strategies may improve long-term survivorship and decrease its global burden. Funding: National Medical Research Council, Singapore, under the Clinician Scientist Award (NMRC/CSA-SI/0014/2017) and the Singapore Translational Research Investigator Award (MOH-000982-01).

Assessing patterns of change in lifestyle behaviours by parity: a longitudinal cohort study.

BACKGROUND: The time constraints and reprioritization of personal health associated with having children may lead women to adopt less healthy lifestyles. We assessed the patterns of change in weight and lifestyle behaviours associated with having children and whether these differ between primiparous and multiparous women. METHODS: Data were from Surveys 3 and 5 of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health. In women who were nulliparous at Survey 3, we assessed changes in weight, energy intake, diet (diet quality, macronutrients and micronutrients), physical activity and sitting time by parity status at Survey 5 using one-way analysis of covariance. RESULTS: Of 4927 eligible women, 2503 gave birth (1090 primiparous and 1413 multiparous) by Survey 5. Women who had given birth 6 years later increased weight (1.0 kg; 95% CI 0.5, 1.5), energy intake (833.9 kJ/day; 95% CI 706.7, 961.1) and diet quality (1.5 units; 95% CI 0.8, 2.1), but decreased physical activity [-405.0 Metabolic Equivalent of Task.min/week; 95% CI -464.2, -345.8] and sitting time (-1.8 h/day; 95% CI -1.9, -1.6) (adjusted mean differences) relative to those who remained nulliparous. In subgroup analysis involving further stratification by parity, the increase in diet quality was only seen in women who became primiparous and the decrease in sitting time was more marked in multiparous women. CONCLUSION: Childbearing is associated with increased weight and energy intake, decreased physical activity, increased diet quality and decreased sitting time. More research targeting weight, energy intake and physical activity for improvement in women during the childbearing years is warranted.

ANDA-Evaluating Facilitated Feedback Enhancement - a Cluster randomised Trial (ANDA-EFFECT): protocol for a cluster randomised trial of audit feedback augmented with education and support, compared to feedback alone, on acceptability, utility and health outcomes in diabetes centres in Australia.

BACKGROUND: People living with diabetes must manage a range of factors for optimal control of glycaemia and to minimise the risk of diabetes-related complications. Diabetes practitioners are expected to follow guidelines for the key process of care and clinical outcomes, to help people living with diabetes achieve clinical targets. In Australia, the performance of diabetes centres against guidelines is evaluated by the Australian National Diabetes Audit, an annual clinical audit and feedback activity. Previous work has identified areas for improvement in the feedback provided to participating diabetes centres and suggested additional educational and support resources to assist in using audit feedback for the development of quality improvement activities. This cluster randomised trial will test the acceptability, utility and impact on selected clinical outcomes of the developed study intervention (audit feedback and a tailored educational and peer support cointervention). METHODS: Two-armed cluster randomised trial with Australian Diabetes Centres that participated in the Australian National Diabetes Audit in 2021 as the clusters, stratified by location and type of centre. We aim to recruit 35 diabetes centres in each arm. Both the intervention and control arms will receive an augmented feedback report, accompanied by a partially pre-populated slide deck. In addition, the intervention arm will receive a tailored theory-based intervention designed to address identified, modifiable barriers to utilising and implementing the recommendations from diabetes audit feedback. The co-primary outcomes are (1) HbA1c at the patient level, measured at 6 months after delivery of the intervention, and (2) the acceptability and utility of the augmented feedback and cointerventions at the practitioner level, measured at 3 months after delivery of the intervention. DISCUSSION: This trial aims to test the effects of systematic development and implementation of theory and evidence-informed changes to the audit feedback delivered to diabetes centres participating in an established national clinical diabetes audit. Potential benefits of improved audit feedback include more optimal engagement with the feedback by end clinical users which, ultimately, may lead to improvements in care for people living with diabetes. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12621000765820. Prospectively registered on June 21, 2021.

Bayesian spatio-temporal modelling of child anemia in Ethiopia using conditional autoregressive model.

Anemia is a common health problem for women and under five children in low income countries. According to the WHO, anemia is considered a serious public health problem when the prevalence is greater than 40%. The prevalence of anemia among children under five in Ethiopia changes over time, and is spatially correlated because it is influenced by environmental, socio-economic and other related factors. However, to our knowledge, there is no small area level estimates of anemia among children under five in Ethiopia. Therefore, this study aimed to assess zonal level estimates of anemia using a Bayesian spatio-temporal conditional autoregressive modeling approach. The data for the study was extracted from the Ethiopian Demographic and Health Surveys (EDHS) from 2005 to 2016. A sample of 18,939 children aged 6-59 months were considered for this study. A Bayesian spatio-temporal conditional autoregressive model was implemented to identify the risk of child anemia. Smoothed relative risks along with the 95% credible interval were reported. The queen's adjacency matrix method was used in spatial smoothing and in estimating the relative risk. The prevalence of anemia among children aged 6-59 months in Ethiopia was 54% in 2005, 44% in 2011 and 57% in 2016. This study showed that low maternal education, low socio-economic status of women, and maternal anemia at zone level were strongly associated with child anemia in Ethiopia. Therefore, enhancing education for women, improving women's socioeconomic status, and mitigating maternal anemia are crucial to reduce the prevalence of childhood anemia in Ethiopia.

Survival of people with cystic fibrosis in Australia.

Survival statistics, estimated using data from national cystic fibrosis (CF) registries, inform the CF community and monitor disease progression. This study aimed to estimate survival among people with CF in Australia and to identify factors associated with survival. This population-based cohort study used prospectively collected data from 23 Australian CF centres participating in the Australian CF Data Registry (ACFDR) from 2005-2020. Period survival analysis was used to calculate median age of survival estimates for each 5-year window from 2005-2009 until 2016-2020. The overall median survival was estimated using the Kaplan-Meier method. Between 2005-2020 the ACFDR followed 4,601 people with CF, noting 516 (11.2%) deaths including 195 following lung transplantation. Out of the total sample, more than half (52.5%) were male and 395 (8.6%) had undergone lung transplantation. Two thirds of people with CF (66.1%) were diagnosed before six weeks of age or by newborn/prenatal screening. The overall median age of survival was estimated as 54.0 years (95% CI: 51.0-57.04). Estimated median survival increased from 48.9 years (95% CI: 44.7-53.5) for people with CF born in 2005-2009, to 56.3 years (95% CI: 51.2-60.4) for those born in 2016-2020. Factors independently associated with reduced survival include receiving a lung transplant, having low FEV1pp and BMI. Median survival estimates are increasing in CF in Australia. This likely reflects multiple factors, including newborn screening, improvement in diagnosis, refinements in CF management and centre-based multidisciplinary care.

Forecasting of overall and aggressive prostate cancer incident counts at the small area level.

OBJECTIVES: This study aims to forecast overall and aggressive prostate cancer counts at the local government area (LGA) level over 10 years (2019-2028) in Victoria, Australia, using Victorian Cancer Registry (2001-2018) data. METHODS: We used the Age-Period-Cohort approach to estimate the annual age-specific incidence in each LGA and used Bayesian spatiotemporal models that account for non-linear temporal trends and area-level risk factors. We evaluated the models' performance by withholding and comparing forecasts with the 2014-2018 data. RESULTS: There were 80,449 prostate cancer cases between 2001 and 2018, with an overall increasing trend. Compared to 2001, prostate cancer incidence increased by 69%, from 3049 to 5167 cases in 2018. Prostate cancer counts are expected to reach 7631 cases in 2028, a further 48% increase. Unexplained area-level spatial variation was substantially reduced after adjusting for the area-level elderly population. Aggressive prostate cancer cases increased by 107% between 2001 and 2018 and are expected to rise by 123% increase in 2028. The proportion of aggressive prostate cancer cases will increase to 31% in 2028 from 20% in 2018. By 2028, overall and aggressive prostate cancer cases are projected to be increasing in 66% and 61% of LGAs. CONCLUSION: Prostate cancer cases are projected to rise at the state level and most LGAs in the next 10 years, with much steeper increases in aggressive cases. Population growth and an ageing population have primarily contributed to this rise besides prostate-specific antigen testing. These prediction estimates help inform prostate cancer burden and facilitate efficient healthcare delivery.

The Profiling of Diet and Physical Activity in Reproductive Age Women and Their Association with Body Mass Index.

Pre-pregnancy, pregnancy and postpartum are critical life stages associated with higher weight gain and obesity risk. Among these women, the sociodemographic groups at highest risk for suboptimal lifestyle behaviours and core lifestyle components associated with excess adiposity are unclear. This study sought to identify subgroups of women meeting diet/physical activity (PA) recommendations in relation to sociodemographics and assess diet/PA components associated with body mass index (BMI) across these life stages. Cross-sectional data (Australian National Nutrition and Physical Activity Survey 2011-2012) were analysed for pre-pregnancy, pregnant and postpartum women. The majority (63-95%) of women did not meet dietary or PA recommendations at all life stages. Core and discretionary food intake differed by sociodemographic factors. In pre-pregnant women, BMI was inversely associated with higher whole grain intake (ß = -1.58, 95% CI -2.96, -0.21; p = 0.025) and energy from alcohol (ß = -0.08, -0.14, -0.005; p = 0.035). In postpartum women, BMI was inversely associated with increased fibre (ß = -0.06, 95% CI -0.11, -0.004; p = 0.034) and PA (ß = -0.002, 95% CI -0.004, -0.001; p = 0.013). This highlights the need for targeting whole grains, fibre and PA to prevent obesity across life stages, addressing those most socioeconomically disadvantaged.

Cryotherapy versus Laser Does Not Influence Anatomic Success after Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair: Registry Analysis of 2413 Patients.

PURPOSE: To determine whether a difference exists between cryotherapy and endolaser photocoagulation retinopexy in terms of the rates of anatomic success after primary rhegmatogenous retinal detachment (RRD) repair with pars plana vitrectomy (PPV). DESIGN: Registry-based, nonrandomized, observational cohort study. SUBJECTS: Eyes with primary RRD in a binational retinal surgery registry that underwent repair with PPV and had a minimum of 3 months of follow-up. METHODS: Cases were recorded prospectively by participating surgeons, and the outcomes were recorded at 3 months. A generalized mixed model approach was used to compare the effect of retinopexy type on the outcomes. Variables known to be associated with retinal surgical success were considered as covariates for the final model. The eyes were divided into 2 groups: Cryo group (receiving cryotherapy as the only form of retinopexy) and Laser group (receiving endolaser as the only form of retinopexy). MAIN OUTCOME MEASURES: The primary endpoint was the proportion of patients with stable retinal reattachment without the need for further retinal detachment surgery, assessed 3 months after the surgery. Failure was defined as either retinal redetachment or foveal attachment with long-term silicone oil tamponade at the endpoint. The secondary outcome measured was visual acuity at 3 months compared with baseline measurements. RESULTS: A total of 2413 patients were included, and the overall single-procedure success rate was 85%. There was no statistically significant difference in surgical success between the adjusted proportion of successful reattachment for the Cryo group (87%) and that of successful reattachment for the Laser group (82%) (P = 0.84; odds ratio, 1.04; 95% confidence interval, 0.74-1.46). There was no difference in the mean change in the visual outcomes at 3 months between the groups (adjusted mean change of -0.48 logarithm of the minimum angle of resolution [logMAR] for the Cryo group vs. -0.50 logMAR for the Laser group, P = 0.82). CONCLUSIONS: The choice of cryotherapy versus endolaser retinopexy was observed to influence neither the anatomic success of PPV for RRD nor the visual acuity outcomes at 3 months after the surgery.