A comparison of alternative measures of alcohol consumption in the Canadian National Survey of alcohol and drug use.

Based on the results of the 1989 National Alcohol and Drug Survey in Canada, this paper compares alternative measures of alcohol consumption. Utilizing questions developed by Walter Clark, the volume of drinking in a variety of social situations is described. The results are presented in terms of aggregate consumption and the proportion of total consumption which occurs in different situations. It is found that anchoring self-reported alcohol use in specific social contexts results in higher estimated consumption than the more commonly used quantity/frequency questions.

Antitumour antibiotic containing regimens for metastatic breast cancer.

BACKGROUND: Antitumour antibiotics are used in the management of metastatic breast cancer. Some of these agents have demonstrated higher tumour response rates than non-antitumour antibiotic regimens, however a survival benefit has not been established in this setting. OBJECTIVES: To identify and review the randomised evidence comparing anti-tumour antibiotic containing chemotherapy regimens with regimens not containing an anti-tumour antibiotic in the management of women with metastatic breast cancer. SEARCH STRATEGY: The specialised register maintained by the Editorial Base of the Cochrane Breast Cancer Group was searched on 2nd May, 2003 using the codes for "advanced breast cancer" and "chemotherapy". Details of the search strategy and coding applied by the Group to create the register are described in the Group's module on The Cochrane Library. SELECTION CRITERIA: Randomised trials comparing anti-tumour antibiotic containing regimens with regimens not containing anti-tumour antibiotics in women with metastatic breast cancer. DATA COLLECTION AND ANALYSIS: Data were collected from published trials. Studies were assessed for eligibility and quality, and data were extracted by two independent reviewers. Hazard ratios (HRs) were derived from time-to-event outcomes where possible, and a fixed effect model was used for meta-analysis. Response rates were analysed as dichotomous variables. Quality of life and toxicity data were extracted where present. A primary analysis was conducted for all trials and by class of antitumour antibiotic. MAIN RESULTS: Thirty-three trials reporting on 45 treatment comparisons were identified. All trials published results for tumour response and 26 trials published time-to-event data for overall survival. The observed 4084 deaths in 5284 randomised women did not demonstrate a statistically significant difference in survival between regimens that contained antitumour antibiotics and those that did not (HR 0.97, 95% CI 0.91 to 1.03, P = 0.35) and no significant heterogeneity. Antitumour antibiotic regimens were favourably associated with time-to-progression (HR 0.84, 95% CI 0.77 to 0.91) and tumour response rates (odds ratio (OR) 1.34, 95% CI 1.21 to 1.48) although statistically significant heterogeneity was observed for these outcomes. These associations were consistent when the analysis was restricted to the 29 trials that reported on anthracyclines. Patients receiving anthracycline-containing regimens were also more likely to experience toxic events compared to patients receiving non-antitumour antibiotic regimens. No statistically significant difference was observed in any outcome between mitoxantrone-containing and non-antitumour antibiotic-containing regimens. REVIEWERS' CONCLUSIONS: Compared to regimens without antitumour antibiotics, regimens that contained these agents showed a statistically significant advantage for tumour response and time to progression in women with metastatic breast cancer but were not associated with an improvement in overall survival. The favourable effect on tumour response and time to progression observed in anthracycline-containing regimens was also associated with greater toxicity.

Drinking in various settings as it relates to demographic variables and level of consumption: findings from a national survey in Canada.

Based on a large-scale 1989 national survey in Canada, the extent of drinking in different social settings is estimated. Home consumption accounts for the greatest share of total drinking. while drinking in licensed establishments accounts for approximately one-fourth of consumption. This estimate is externally validated against scales data. The set of questions on drinking venues produces estimates of individual's alcohol consumption which have higher coverage rates than the more commonly used quantity-frequency or recent occasion approaches. The distribution of total drinking in different settings is strongly related to demographic variables and individual level of consumption. In particular, drinking in bars and taverns is related to higher levels of drinking and self-reported drinking problems. The proportion of drinking in different venues is not strongly related to drinking problems, once demographic variables and individual consumption patterns are taken into account. This does not mean that drinking venue is not a significant factor in the development of problems--it may be via its impact on consumption level and heavy drinking occasions that drinking venue relates to drinking problems.

Assessing stated preferences for colorectal cancer screening: a critical systematic review of discrete choice experiments.

BACKGROUND: It is well established that screening is effective in reducing the incidence and mortality associated with colorectal cancer (CRC). National screening programs have been implemented in many countries; however, uptake remains an issue. Understanding patient preferences may assist in shaping screening programs and tailoring information about screening tests. OBJECTIVE: Our objective was to undertake a systematic review of discrete choice experiments (DCEs) of CRC screening. METHODS: A systematic review of DCEs of CRC screening was undertaken in an average-risk general population. The methodological qualities of the studies were assessed using a standard checklist outlining best practice for conjoint studies. RESULTS: Nine studies met the selection criteria. Meta-analysis was not possible due to the heterogeneity of the data and methods. However, in eight studies, attributes describing accuracy and/or clinical effectiveness were reported to be statistically significant. We also found that individuals were willing to trade-off other attributes such as an increased risk of complications to gain greater clinical benefits. Screening was also preferred to non-screening by the majority of respondents, regardless of the test used. CONCLUSIONS: Understanding and incorporating individuals' preferences in decision making is increasingly considered essential in the health field. Data from DCEs can provide valuable insights into the trade-offs individuals are willing to undertake in respect to CRC screening. Such insights can be used by decision makers to identify screening tests that could maximize informed uptake. It is likely that, with better reporting and evolving methodology, the contribution that DCEs can make to such debates will increase.