Sociodemographic characteristics and clinical outcomes for people presenting to emergency departments with mental health diagnoses.

BACKGROUND: Hospital emergency departments (EDs) are experiencing a growth in presentations with mental health (MH) diagnoses. AIM: Describe and compare sociodemographic characteristics and clinical outcomes for people with MH and non-MH diagnoses. METHODS: A retrospective study examined routinely collected data for ED presentations in a health district in western Sydney, Australia from 2016 to 2019. Regression models examined variables according to MH status, overall and by age. RESULTS: Individuals with MH diagnoses accounted for 3.4% of 647,787 ED presentations. MH presentations were most commonly female (51.5%), aged 16-39 years (62.5%), arrived after hours (60.3%) and via ambulance (52.8%). MH presentations were more likely to be triaged category 2 (OR = 1.58,95%CI = 1.54-1.63) and not seen on time (OR = 1.20,95%CI = 1.17-1.24). They had higher odds of a longer ED stay (OR = 1.96,95%CI = 1.90-20.1), after which they were less likely to be admitted (OR = 0.56, 95%CI = 0.55-0.58) and more likely to be transferred (OR = 3.81,95%CI = 3.66-3.97) or leave before treatment was completed (OR = 1.83,95%CI = 1.74-1.92). CONCLUSION: Characteristics and outcomes for people presenting to ED with a MH diagnosis significantly differ from those without a MH diagnosis. Provision of timely care is a particular concern. Identifying causes for delays within and external to the ED, and implementing targeted strategies to ameliorate them are required to optimise care.

Associations between walkability and pedestrian related injuries is modified by sociodemographic characteristics.

BACKGROUND: Walkability scores have been developed to measure how well the characteristics of the physical environment support walking. However, because pedestrian safety is not taken into account, areas that have higher Walk Scores could be associated with more walking and also more pedestrian-related injury. We aimed to explore the association between Walk Score and pedestrian-related injury in Sydney. METHOD: Pedestrian-related injuries from 2010 to 2018 in Sydney were identified in the New South Wales Combined Admitted Patient Epidemiology Data. Walk Score was used to measure area-level walkability in Sydney statistical division. Regression models were used to examine the association between Walk Score, pedestrian-related injury, length of hospital stay (LOS) and injury severity. RESULT: Among people aged ≤64 years, there was no significant association between walkability score and pedestrian-related injury. Among people aged ≥ 65 years, walkability score was significantly positively associated with pedestrian-related injury, which peaked at Somewhat Walkable. For most disadvantaged areas, the risk of pedestrian-related injury was highest for areas that were classified as Somewhat Walkable. For moderately disadvantaged areas, the risk of pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas. For the least disadvantaged areas, there was no significant association between walkability score and pedestrian-related injury. For LOS among people aged ≥ 65 years or in the most disadvantaged areas, it peaked at Somewhat Walkable areas. For injury severity, the risk of serious pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas among people aged 16-64 years. CONCLUSION: For the majority of the population, built environment characteristics that are considered to make walking attractive also make it safer, offsetting any exposure-related increase injury risk. However, this is not the case for people aged ≥ 19 years, and those living in socioeconomically disadvantaged areas. Incorporating measures of pedestrian safety in walkability scores may create an impetus to ensure that the built environment is designed to support the safety of pedestrians from these groups.

Exploring the Use of Hospital and Community Mental Health Services Among Newly Resettled Refugees.

Importance: Resettled refugees in high-income countries represent a vulnerable population. It is known that refugees have high rates of trauma-related mental health issues; however, ad hoc research has generally revealed low rates of health services use among refugees. Such research usually samples a population at a single point in time and is based on targeted surveys. Because refugee populations change over time, such research becomes expensive and time-consuming for agencies interested in routinely publishing statistics of mental health services use among refugees. The linking of large administrative data sets to establish rates of use of mental health services among resettled refugees is a flexible and relatively inexpensive approach. Objective: To use data linkage to establish rates of mental health services use among resettled refugees relative to the general population. Design, Setting, and Participants: This cross-sectional study implemented data linkage from the Refugee Health Nurse Program for 10 050 refugees who resettled in Sydney, Australia, from October 23, 2012, to June 8, 2017, with data concerning use of community mental health services and mental health hospitalization from New South Wales Health databases. Data were analyzed between June 1, 2019, and December 31, 2021. Main Outcomes and Measures: Rates of service contacts with community mental health services among the resettled refugees were compared with those of the general population by age, sex, and the most common International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes. Length of community mental health service sessions and rates of mental health hospitalizations were also compared. Results: Among the 255 resettled refugees who had contacts with community mental health care services and were not missing data (median age, 35 [range, 4-80] years; 117 [64%] male and 138 [54%] female), 153 (60%) were born in Iraq and 156 (61%) were Arabic speaking. This population was less likely to use mental health services than the general population and had shorter community mental health consultations. The rate of contacts with community mental health services for depressive disorders among the resettled refugee population was 40% (95% CI, 33%-46%) lower than that among the general population. Rates of same-day hospitalization per 10 000 person-years were not significantly different between the refugee population (4 [95% CI, 2-8]) and the general Australian population (7 [95% CI, 7-7]). However, the refugee population was 17% (95% CI, 6%-29%) more likely than the general Australian population to interact with the community mental health system for severe stress- and adjustment disorder-related diagnoses. Conclusions and Relevance: These findings suggest that refugees who have resettled in Australia tend to use fewer mental health services than the general population except for services devoted to stress- and adjustment disorder-related diagnoses. These findings also suggest that it is possible to successfully leverage data linkage to study patterns of mental health services use among resettled refugees.

Diabetes and the use of primary care provider services in rural, remote and metropolitan Australia.

INTRODUCTION: Public health agencies around the world are concerned about an ever-increasing burden of type 2 diabetes and related disability. Access to primary care providers (PCPs) can support early diagnosis and management. However, there is limited literature on how frequently older people with diabetes access PCPs, and their levels of access in rural Australia relative to metropolitan areas. METHODS: In this research, patterns of PCP use among those with diagnosed diabetes and those without diagnosed diabetes (referred to as 'healthy' individuals) were compared using a large survey of more than 230 000 people aged 45 years and older from New South Wales, Australia. A published model to study the PCP access patterns of a group of individuals with diabetes risk was used. RESULTS: Annual visits to PCPs among people aged 45 years or more with diabetes in rural areas, while higher than for healthy rural residents, were significantly lower than their metropolitan counterparts, mirroring similar disparities in PCP use across the rural-urban divide in the healthy population. Similar patterns were present in the high-risk population. Nevertheless, people with diabetes visited PCPs around four times a year, which is around the recommended number of annual visits, although some groups (eg those with comorbidities) may need more visits. CONCLUSION: Patterns of PCP use among rural residents, while significantly less frequent than their metropolitan counterparts, are at the recommended level for people with diabetes.

Which Green Space Metric Best Predicts a Lowered Odds of Type 2 Diabetes?

The choice of a green space metric may affect what relationship is found with health outcomes. In this research, we investigated the relationship between percent green space area, a novel metric developed by us (based on the average contiguous green space area a spatial buffer has contact with), in three different types of buffers and type 2 diabetes (T2D). We obtained information about diagnosed T2D and relevant covariates at the individual level from the large and representative 45 and Up Study. Average contiguous green space and the percentage of green space within 500 m, 1 km, and 2 km of circular buffer, line-based road network (LBRN) buffers, and polygon-based road network (PBRN) buffers around participants' residences were used as proxies for geographic access to green space. Generalized estimating equation regression models were used to determine associations between access to green space and T2D status of individuals. It was found that 30%-40% green space within 500 m LBRN or PBRN buffers, and 2 km PBRN buffers, but not within circular buffers, significantly reduced the risk of T2D. The novel average green space area metric did not appear to be particularly effective at measuring reductions in T2D. This study complements an existing research body on optimal buffers for green space measurement.

Tree Canopy Cover Is Best Associated with Perceptions of Greenspace: A Short Communication.

A growing literature has supported a relationship between greenspace and health. Various greenspace metrics exist; some are based on subjective measures while others are based on an objective assessment of the landscape. While subjective measures may better reflect individual feelings about surrounding greenspace and the resulting positive benefits thereof, they are expensive and difficult to collect. In contrast, objective measures can be derived with relative ease, in a timely fashion, and for large regions and populations. While there have been some attempts to compare objective and subjective measures of greenspace, what is lacking is a comprehensive assessment of a wide range of greenspace metrics against subjective measures of greenspace. We performed such an assessment using a set of three objective greenspace metrics and a survey of residents in Liverpool, New South Wales, Australia. Our study supported existing findings in that overall, there is very little agreement between perceived and objective greenspace metrics. We also found that tree canopy in 10 min walking buffers around residences was the objective greenspace measure in best agreement with perceived greenspace.

Spatial clusters of chronic preventable hospitalizations (ambulatory care sensitive conditions) and access to primary care.

BACKGROUND: Potentially preventable hospitalizations (PPHs) or ambulatory care sensitive conditions (ACSCs) represent hospitalizations that could be successfully managed in a primary care setting. Research from the USA and elsewhere on the role of primary care provider (PCP) access as a PPH driver has been conflicting. We investigated the role of PCP access in the creation of areas with persistently significant high rates of PPHs over time or PPH hotspots/spatial clusters. METHODS: Using a detailed dataset of PCPs and a dataset of 106 334 chronic PPH hospitalizations from South Western Sydney, Australia, we identified hotspots of chronic PPHs. We contrasted how hotspot PPHs were different from other PPHs on a range of factors including PCP access. RESULTS AND CONCLUSIONS: Six spatially contiguous areas comprising of eight postcodes were identified as hotspots with risks ranging from 1.6 to 2.9. The hotspots were found to be more disadvantaged and had better PCP access than other areas. Socioeconomic disadvantage explained the most variation (8%) in clustering while PCP access explained only a small fraction though using detailed PCP access measures helped. Nevertheless a large proportion of the variation remained unexplained (86.5%) underscoring the importance of individual level behaviours and other factors in driving chronic PPH clustering.

Prognostic utility of serial 18F-FDG-PET/CT in patients with locally advanced rectal cancer who underwent tri-modality treatment.

OBJECTIVE: This study explored the value of serial 18-fludeoxyglucose-positron emission tomography (18F-FDG-PET/CT) in predicting disease-free survival (DFS) in locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiation (NCRT) and surgery. METHODS: We prospectively studied 46 patients with LARC who underwent NCRT and surgery. 18F-FDG-PET/CT scans were performed at three time-points before surgery (pre-NCRT-PET1, during NCRT-PET2 and following completion of NCRT-PET3). The following semi-quantitative PET parameters were analysed at each time point: maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG). Absolute and percentage changes in these parameters were analysed between time points. Statistical analysis consisted of median tests, Cox regression and Kaplan-Meier analysis for DFS. RESULTS: The median follow-up time was 24 months. A reduction in PET parameters showed statistically significant differences for patients with recurrence compared to those without; percentage changes in MTV between PET1 and PET3 (cut-off: 87%, p = 0.023), percentage changes in TLG between PET1 and PET3 (cut-off: 94%, p = 0.02) and absolute change in MTV PET1 and PET2 (cut-off: 10.25, p = 0.001).An absolute reduction in MTV between PET1 and PET3 (p=0.013), a percentage reduction in TLG between PET1 and PET2 (p=0.021), SUVmax and SUVmean at PET2 (p = 0.01, p = 0.027 respectively)were also prognostic indicators of recurrence.MTV percentage change between PET1 and PET2 and SUVmean percentage change between PET1 and PET3 were also trending towards significance (p = 0.052, p = 0.053 respectively). CONCLUSION: Serial 18F-FDG-PET/CT is a potentially reliable non-invasive method to predict recurrence in patients with LARC. Volumetric parameters were the best predictors. This could allow risk-stratification in patients who may benefit from conservative management. ADVANCES IN KNOWLEDGE: This paper will add to the literature in risk-stratifying patients with LARC based on prognosis, using 18F-FDG-PET/CT. This may improve patient outcomes by selecting suitable candidates for conservative management.

Neighbourhood greenspace and physical activity and sedentary behaviour among older adults with a recent diagnosis of type 2 diabetes: a prospective analysis.

OBJECTIVES: Greenspace is one of the important factors that can promote an active lifestyle. Thus, greener surroundings may be a motivating factor for people with newly diagnosed diabetes to engage in more physical activity. Given that diagnosis of type 2 diabetes (T2D) may serve as a window opportunity for behavioural modification, we hypothesise that the association between neighbourhood greenspace and physical activity among people with newly diagnosed T2D may be greater than those not diagnosed with T2D. The aim of this study was to investigate the association between access to greenspace and changes in physical activity and sedentary behaviour, and whether these associations differed by T2D. DESIGN: Prospective cohort. SETTING: New South Wales, Australia. METHODS: We used self-reported information from the New South Wales 45 and Up Study (baseline) and a follow-up study. Information on sitting, walking and moderate to vigorous physical activity was used as outcomes. The proportion of greenspace within 500 m, 1 km and 2 km road network buffers around participant's residential address was generated as a proxy measure for access to greenspace. The association between the access to greenspace and the outcomes were explored among the newly diagnosed T2D group and those without T2D. RESULTS: Among New T2D, although no significant changes were found in the amount of walking with the percentage of greenspace, increasing trends were apparent. There was no significant association between the percentage of greenspace and changes in amount of moderate to vigorous physical activity (MVPA). Among No T2D, there were no significant associations between the amount of MVPA and walking, and percentage of greenspace. For changes in sitting time, there were no significant associations with percentage of greenspace regardless of buffer size. CONCLUSIONS: In this study, there was no association between access to greenspace at baseline and change in walking, MVPA and sitting time, regardless of T2D status.

Adverse drug reactions due to opioid analgesic use in New South Wales, Australia: a spatial-temporal analysis.

BACKGROUND: Pharmaceutical opioid analgesic use continues to rise and is associated with potentially preventable harm including hospitalisation for adverse drug reactions (ADRs). Spatial detection of opioid-related ADRs can inform future intervention strategies. We aimed to investigate the geographical disparity in hospitalised ADRs related to opioid analgesic use, and to evaluate the difference in patient characteristics between areas inside and outside the geographic clusters. METHODS: We used the all-inclusive Admitted Patient Dataset for an Australian state (New South Wales, NSW) to identify patients admitted for opioid-related ADRs over a 10-year period (July 2004 to June 2014). A space-time analysis was conducted using Kulldroff's scan statistics to identify statistically significant spatial clusters over time. Relative risk (RR) was computed with p-value based on Monte Carlo Simulation. Chi-square test was used to compare proportional difference in patient clustering. RESULTS: During the study period, we identified four statistically significant geographic clusters (RRs: 1.63-2.17) during 2004-08; and seven clusters (RRs: 1.23-1.69) during the period 2009-14. While identified high-risk clusters primarily covered areas with easier access to health services, those associated with socioeconomically disadvantaged areas and individuals with mental health disorders experienced more unmet healthcare needs for opioid analgesic safety than those from the rest of the State. Older people (≥65 years and over) accounted for 62.7% of the total study population and were more susceptible to opioid-related ADRs than younger people,. In the first five-year period the clusters included a greater proportion of people with cancer in contrast to the second five-year period in which there was a lesser proportion of people with cancer. CONCLUSIONS: These results suggest that there is significant spatial-temporal variation in opioid-related ADRs and future interventions should target vulnerable populations and high-risk geographical areas to improve safer use of pharmaceutical opioid analgesics.

Patterns of comorbidities in hospitalised cancer survivors for palliative care and associated in-hospital mortality risk: A latent class analysis of a statewide all-inclusive inpatient data.

BACKGROUND: At the end of life, cancer survivors often experience exacerbations of complex comorbidities requiring acute hospital care. Few studies consider comorbidity patterns in cancer survivors receiving palliative care. AIM: To identify patterns of comorbidities in cancer patients receiving palliative care and factors associated with in-hospital mortality risk. DESIGN, SETTING/PARTICIPANTS: New South Wales Admitted Patient Data Collection data were used for this retrospective cohort study with 47,265 cancer patients receiving palliative care during the period financial year 2001-2013. A latent class analysis was used to identify complex comorbidity patterns. A regression mixture model was used to identify risk factors in relation to in-hospital mortality in different latent classes. RESULTS: Five comorbidity patterns were identified: 'multiple comorbidities and symptoms' (comprising 9.1% of the study population), 'more symptoms' (27.1%), 'few comorbidities' (39.4%), 'genitourinary and infection' (8.7%), and 'circulatory and endocrine' (15.6%). In-hospital mortality was the highest for 'few comorbidities' group and the lowest for 'more symptoms' group. Severe comorbidities were associated with elevated mortality in patients from 'multiple comorbidities and symptoms', 'more symptoms', and 'genitourinary and infection' groups. Intensive care was associated with a 37% increased risk of in-hospital deaths in those presenting with more 'multiple comorbidities and symptoms', but with a 22% risk reduction in those presenting with 'more symptoms'. CONCLUSION: Identification of comorbidity patterns and risk factors for in-hospital deaths in cancer patients provides an avenue to further develop appropriate palliative care strategies aimed at improving outcomes in cancer survivors.

Factors predicting recurrence of gestational diabetes in a high-risk multi-ethnic population.

BACKGROUND: Women with gestational diabetes mellitus (GDM) have an increased risk of adverse pregnancy outcomes. This study examined predictors for GDM recurrence at their next pregnancy in a multi-ethnic population. Clinical outcomes of women with GDM at the index as well as the subsequent pregnancies were also compared. MATERIALS AND METHODS: A retrospective review of women with GDM (between 2008 and 2016) who had a subsequent pregnancy at a tertiary institution was conducted. The clinical characteristics of both pregnancies were documented. RESULTS: Among 3587 singleton pregnancies complicated by GDM, 501 fell pregnant again and 367 (73.1%) developed GDM in their subsequent pregnancies. Subsequent pregnancies had higher birthweight (3426 ± 563 vs 3290 ± 506 g, P < 0.001) but the rate of pre-eclampsia was lower (1.0% vs 4.2%, P = 0.003). Univariate analysis showed that older age, prior history of GDM, pre-pregnant body mass index (BMI), two-hour glucose level on glucose tolerance test (GTT), insulin requirement at the index pregnancy, and inter-pregnancy weight gain were associated with recurrent GDM. Using stepwise logistic regression analysis, pre-pregnant BMI, glucose levels on GTT at index pregnancy and inter-pregnancy weight gain were independent predictors for recurrent GDM. The odds ratios for recurrent GDM among those who gained more than 8 kg were 20.5 (5.0-84.5), compared with those who lost over 5 kg between the two pregnancies. GDM recurrence rate was independent of ethnic backgrounds. CONCLUSION: Women with GDM have high risk of GDM recurrence at their next pregnancy. Inter-pregnancy weight gain is a strong predictor of recurrent GDM, and strategies to help women lose weight post-partum may be invaluable.

Trends in adverse drug reaction-related hospitalisations over 13 years in New South Wales, Australia.

BACKGROUND: Adverse drug reactions (ADR) are severe problems in global public health, and result in high mortality and morbidity. Various trends of ADR-related hospitalisations have been studied in many countries, while estimates of the trends in Australia are limited. AIM: To examine trends in ADR-related hospitalisations in New South Wales (NSW). METHODS: Data were extracted from the Admitted Patient Data Collection, a census of hospital separations in NSW. We estimated age-adjusted rates of ADR-related hospitalisation between 1 July 2001 and 30 June 2014 and rates by patient characteristics, main therapeutic medication groups and clinical condition groups that warranted the hospitalisation. We used the percentage change annualised estimator to evaluate rates over time. RESULTS: A total of 315 274 NSW residents admitted for urgent care of ADR was identified. The age-adjusted rates of ADR-related hospitalisations nearly doubled and increased by 5.8% (95% CI: 5.0-6.6%) per annum, with an in-hospital death rate increase of 2.4% (1.6-3.3%). Agranulocytosis (2.7%), nausea and vomiting (2.4%) and heart failure (2.4%) were the most common conditions that led to ADR-related hospitalisations over 13 years, with acute renal failure (1.4%) recently emerging as the leading adverse condition. Participants aged between 65 and 84 years accounted for nearly half of ADR hospitalisations (45.6%), with age-adjusted rate increasing from 103.9 in 2001-2002 to 189.0 per 100 000 NSW residents in 2013-2014. Anticoagulants (13.5%) were the most common medications contributing to ADR-related hospitalisation, followed by opioid analgesics (9.6%). CONCLUSION: ADR-related hospitalisation remains a population health burden, with significant increase over time. The findings call for continuing efforts to prevent ADR, especially among high-risk populations, such as older people.

Bonding of composite cements to zirconia: A systematic review and meta-analysis of in vitro studies.

OBJECTIVES: The aim of this study was to systematically review the literature and statistically analyze bond strength data to identify the influence that composite cements, type of test methodology, chemical and mechanical pre-treatments have on the bond strength of composite cements to zirconia in three different artificial aging conditions. METHODS: The literature was electronically searched in MEDLINE, PUBMED, EMBASE, and SCOPUS to select relevant articles that evaluated the bond strength between zirconia and composite cements. A manual search was performed by scanning the reference lists of included studies. All articles were published online before December 2016 and in English. From electronic database and manual searches, 444 studies were identified; 161 articles with 1632 test results met the inclusion criteria. Test results were assigned into 3 aging conditions: non-aged, intermediate-aged and aged groups. Generalized estimating equations (GEE) were used to explore actual mean bond strengths. As the bond strength is a non-negative value, lognormal distribution was used. RESULTS: In non-aged condition, data showed statistically significant interactions between cement type and type of test. There was no statistically significant interaction between mechanical and chemical pre-treatments. In intermediate-aged and aged conditions, data showed no statistically significant interactions between mechanical and chemical pre-treatments and between cement type and type of test. CONCLUSIONS: This meta-analysis appeared to indicate that mechanical pre-treatments, and in particular ceramic coating, combined with methacryloyloxydecyl dihydrogen phosphate (MDP) containing primers yielded the highest long-term bond strength (aged-condition). However, data are limited and caution should be exercised before applying these results to clinical situations.

Variations in breast cancer histology and treatment patterns between the major ethnic groups of South West Sydney.

Studies in the United States and United Kingdom have demonstrated ethnic variations in breast cancer receptor status, histology, and treatment access. This study aimed to investigate whether ethnicity variation similarly exists in Australia. Patients diagnosed with breast cancer between 2006 and 2011 across all public hospitals in the South Western Sydney Local Health District were identified and patient data collected retrospectively. Logistic regression analysis was used to measure the association between various biologic and treatment parameters and ethnicity. Ethnicity was found to have an influence on age of diagnosis, histology, treatment utilization, and recurrence in breast cancer patients.

Lifestyle Changes After a Diagnosis of Type 2 Diabetes.

OBJECTIVE: Whether patients with type 2 diabetes change their lifestyle in response to their diagnosis and maintain behavior changes is unclear. This study aimed to 1) compare changes in lifestyle behaviors among participants who were newly diagnosed with type 2 diabetes and those never diagnosed with type 2 diabetes and 2) investigate changes in lifestyle behaviors in relation to the duration of newly diagnosed type 2 diabetes. METHODS: We used self-reported information from the New South Wales 45 and Up Study and a follow-up study. Changes in body weight; amount of walking, moderate to vigorous physical activity (MVPA), and sitting; fruit and vegetable consumption; and smoking status and number of cigarettes smoked were used as measures of health behavior change. These variables were compared between participants in a "new type 2 diabetes" group and a "no type 2 diabetes" group. RESULTS: The new type 2 diabetes group had a smaller decrease in vegetable consumption, lost more weight, and were more likely to quit smoking than the no type 2 diabetes group. MVPA, fruit consumption, and number of cigarettes smoked did not change significantly for either group. Although no significant changes were found in any of the health behaviors based on time since diagnosis, the magnitude of changes in weight and walking increased as duration of diagnosis increased, whereas changes in MVPA, number of cigarettes smoked, and proportion of participants who quit smoking decreased. CONCLUSION: In this population-based study, participants with incident type 2 diabetes reported only minimal changes in their lifestyle factors after receiving their diagnosis.

Serial imaging using [18F]Fluorodeoxyglucose positron emission tomography and histopathologic assessment in predicting survival in a population of surgically resectable distal oesophageal and gastric adenocarcinoma following neoadjuvant therapy.

BACKGROUND AND OBJECTIVES: We retrospectively evaluated the value of PET/CT in predicting survival and histopathological tumour-response in patients with distal oesophageal and gastric adenocarcinoma following neoadjuvant treatment. METHODS: Twenty-one patients with resectable distal oesophageal adenocarcinoma and 14 with gastric adenocarcinoma between January 2002 and December 2011, who had undergone serial PET before and after neoadjuvant therapy followed by surgery, were enrolled. Maximum standard uptake value (SUVmax) and metabolic tumour volume were measured and correlated with tumour regression grade and survival. RESULTS: Histopathological tumour response (PR) is a stronger predictor of overall and disease-free survival compared to metabolic response. ∆%SUVmax ≥70% was the only PET metric that predicted PR (82.4% sensitivity, 61.5% specificity, p = 0.047). Histopathological non-responders had a higher risk of death (HR 8.461, p = 0.001) and recurrence (HR 6.385, p = 0.002) and similarly in metabolic non-responders for death (HR 2.956, p = 0.063) and recurrence (HR 3.614, p = 0.028). Ordinalised ∆%SUVmax showed a predictive trend for OS and DFS, but failed to achieve statistical significance. CONCLUSIONS: PR was a stronger predictor of survival than metabolic response. ∆%SUVmax ≥70% was the best biomarker on PET that predicted PR and survival in oesophageal and gastric adenocarcinoma. Ordinalisation of ∆%SUVmax was not helpful in predicting primary outcomes.

Assessing guideline adherence and patient outcomes in cervical cancer.

AIM: To investigate adherence to clinical practice guidelines (CPGs) in cervical cancer and the correlation with clinical outcomes. METHODS: A retrospective analysis was conducted using patient information from a population-based cancer registry (2005-2011, n = 208). Compliance to 10 widely accepted CPGs was assessed. Univariate and multivariate analyses were performed to assess sociodemographic factors associated with CPG adherence. Multivariate Cox regression was performed to assess the relationship between CPG adherence and 5-year survival. RESULTS: Adherence to individual CPGs ranged from 47% to 100%. Compliance to all applicable CPGs was seen in 54% (n = 72) of patients, 62% of stage I and II patients and 22% of stage III and IV patients. Poorest adherence was seen with those with locally advanced disease receiving chemoradiotherapy. Patients who lived within 5 km of the treatment facility were more likely to be compliant. No difference was found for either age, country of birth or socioeconomic status group. Five-year survival was greater for stage I and II patients who received guideline adherent care (93.7% vs 69.7%, P = 0.002), and they had a significant lower risk of death on multivariate analysis (HR = 0.22, P = 0.015). There was no significant difference for those with stage III or IV disease. CONCLUSIONS: In this study, CPG adherence is variable between treatment modalities and only half complied to all applicable CPGs. There was better adherence in those with early-stage disease and this was associated with improved patient outcomes. CPG adherence may be a useful surrogate for quality of care.

Effects of Distant Green Space on Physical Activity in Sydney, Australia.

BACKGROUND: The aim was to investigate the association between distant green space and physical activity modified by local green space. METHODS: Information about physical activity, demographic and socioeconomic background at the individual level was extracted from the New South Wales Population Health Survey. The proportion of a postcode that was parkland was used as a proxy measure for access to parklands and was calculated for each individual. RESULTS: There was a significant relationship between distant green space and engaging in moderate-to-vigorous physical activity (MVPA) at least once a week. No significant relationship was found between adequate physical activity and distant green space. No significant relationships were found between adequate physical activity, engaging in MVPA, and local green space. However, if respondents lived in greater local green space (≥25%), there was a significant relationship between engaging in MVPA at least once a week and distance green space of ≥20%. CONCLUSION: This study highlights the important effect of distant green space on physical activity. Our findings also suggest that moderate size of local green space together with moderate size of distant green space are important levers for participation of physical activity.