Prevention of breast cancer in the context of a national breast screening programme.

Breast cancer is not only increasing in the west but also particularly rapidly in eastern countries where traditionally the incidence has been low. The rise in incidence is mainly related to changes in reproductive patterns and lifestyle. These trends could potentially be reversed by defining women at greatest risk and offering appropriate preventive measures. A model for this approach was the establishment of Family History Clinics (FHCs), which have resulted in improved survival in younger women at high risk. New predictive models of risk that include reproductive and lifestyle factors, mammographic density and measurement of risk-associated single nucleotide polymorphisms (SNPs) may give more precise information concerning risk and enable better targeting for mammographic screening programmes and of preventive measures. Endocrine prevention using anti-oestrogens and aromatase inhibitors is effective, and observational studies suggest lifestyle modification may also be effective. However, referral to FHCs is opportunistic and predominantly includes younger women. A better approach for identifying older women at risk may be to use national breast screening programmes. Here were described pilot studies to assess whether the routine assessment of breast cancer risk is feasible within a population-based screening programme, whether the feedback and advice on risk-reducing interventions would be welcomed and taken up, and to consider whether the screening interval should be modified according to breast cancer risk.

Knee joint kinematics from familiarised treadmill walking can be generalised to overground walking in young unimpaired subjects.

We studied the familiarisation time required for reliable sagittal-plane knee kinematics and temporal-distance gait measurements to be obtained from treadmill walking. We also studied whether knee kinematics and temporal-distance gait measurements obtained from familiarised treadmill walking can be generalised to overground walking. Sixteen subjects without pathology walked on a level overground walkway and on a treadmill. A motion measurement system was used to measure sagittal plane knee movements and temporal-distance gait parameters during overground and treadmill walking. Highly reliable knee kinematics and temporal-distance gait measurements [intraclass correlation coefficient (ICC)(2,1)>/=0.93] were found after 6 min of treadmill walking. These measurements, obtained after 6 min of treadmill walking, were highly correlated with and not significantly different to those of overground walking. Reliable measurements that can be generalised to overground walking, can be obtained from the treadmill within a familiarisation time of 6 min.

Breast cancer susceptibility variants alter risk in familial ovarian cancer.

Recent candidate gene and genome wide association studies have revealed novel loci associated with an increased risk of breast cancer. We evaluated the effect of these breast cancer associated variants on ovarian cancer risk in individuals with familial ovarian cancer both with and without BRCA1 or BRCA2 mutations. A total of 158 unrelated white British women (54 BRCA1/2 mutation positive and 104 BRCA1/2 mutation negative) with familial ovarian cancer were genotyped for FGFR2, TNRC9/TOX3 and CASP8 variants. The p.Asp302His CASP8 variant was associated with reduced ovarian cancer risk in the familial BRCA1/2 mutation negative ovarian cancer cases (P = 0.016). The synonymous TNRC9/TOX3 (Ser51) variant was present at a significantly lower frequency than in patients with familial BRCA1/2 positive breast cancer (P = 0.0002). Our results indicate that variants in CASP8 and TNRC9/TOX3 alter the risk of disease in individuals affected with familial ovarian cancer.

Hospital stay and discharge outcomes after knee arthroplasty.

The impact of shorter hospital lengths of stay on patient outcomes at discharge from acute care after knee arthroplasty was investigated in a prospective observational outcome study at three Melbourne public hospitals during a 5-month period from October 1999 to March 2000. The participants were 105 consecutive patients (35 at each hospital), with a mean age of 71 years. Outcome measures were length of stay, destination (home or rehabilitation) and functional mobility at discharge from the acute care facility. During the study period mean hospital length of stay across the three hospitals was 6.5 days, more than 30% less than the Victorian average for the preceding year. This was associated with high rates of discharge to rehabilitation facilities (mean 64%), with rates varying between the three hospitals (97%, 57% and 40%). However, in each hospital, one-third of this group had already achieved a level of independent functional mobility adequate for discharge home, highlighting an apparent influence of non-clinical factors on discharge decisions, including pressure to decrease length of stay, hospital policy and availability of a rehabilitation bed. Ways of achieving discharge directly home for a greater number of patients following knee arthroplasty and of determining optimal length of stay are discussed.

Identifying participation rates at outpatient cardiac rehabilitation programs in Victoria, Australia.

BACKGROUND: Much has been achieved in implementing structured outpatient cardiac rehabilitation (CR) programs in Victoria, Australia, but little is known about the percentage of eligible patients who participate. This study was undertaken to determine the feasibility of establishing a database of CR participants and comparing it to the Victorian Inpatient Minimum Database (VIMD), a routinely collected hospital morbidity data set documenting all admissions to Victorian public and private hospitals. This would enable program participants and nonparticipants to be identified and program participation rates to be calculated. METHODS: Data on program participants were collected from a sample of eight CR programs. Records from the VIMD were extracted for the concurrent time period for patients discharged home after acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery, and percutaneous transluminal coronary angioplasty (PTCA), and therefore considered eligible to participate. Victorian Inpatient Minimum Database data were aggregated according to program catchment areas. Data were compared for program participants and patients eligible to participate. RESULTS: Seven hundred fifty-eight patients were identified as being eligible to attend; 240 (32%) were identified as participating at least once. Discharged CABG patients participated on average at a rate of 53.1%, compared with 27.2% of AMI patients and only 10.3% of PTCA patients. CONCLUSIONS: Despite a comprehensive network of CR programs in Victoria, they are used on average by only a minority of eligible patients. Further work is required to determine barriers to participation to develop strategies to increase participation rates.