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Biomedical subjects

Andrew Page

Publications and source records attributed to Andrew Page.

14 recordsLinked to original sources
PubMed2006

Divergent trends in suicide by socio-economic status in Australia.

OBJECTIVES: This study investigated secular trends in socio-economic status (SES) differentials in Australian suicide (1979-2003), which includes overall declines in male suicide from 1998. METHOD: Suicide rates were stratified by approximate equal-population quintiles of area-based SES for the period 1979-2003 and examined across five quinquennia, centred on each Australian Census from 1981 to 2001, to determine if (1) SES differentials in suicide have persisted over time, and (2) if SES differentials have widened or narrowed. Suicide rates (per 100,000) were adjusted for confounding by sex, age, country-of-birth, and urban-rural residence using Poisson regression models, and secular changes in SES differentials were assessed using trend tests on suicide rate ratios (low to high SES quintiles). RESULTS: Socio-economic status (SES) differentials persisted across the study period for both males and females after adjusting for the effects of age, migrant status, and urban-rural residence, with the largest differences between low and high SES groups evident in males, and especially young males (20-34 years). For males, suicide rates increased significantly in all SES groups until 1998, before diverging significantly in the most recent 5-year period, particularly in younger males (P<0.0001). In young males, suicide rates in the most recent period increased in the low SES group from 44.8 in 1994-1998 to 48.6 in 1999-2003 (an 8% increase). In contrast, suicide rates in the middle SES group decreased from a peak of 37.3 to 33.5 (a 10% decrease), and in the high SES group from a peak of 33.0 to 27.9 (a 15% decrease). A similar statistically significant divergence of a lesser magnitude was also evident in all age males and younger females (20-34 years). CONCLUSION: This study shows that SES differentials in suicide persisted in Australia for most of the period 1979-2004. The decline in suicide in young males in the most recent quinquennium was limited to middle and high SES groups, while the low SES group displayed a continued increase. The continued increase in suicide in low SES males has implications for social and economic intervention and suicide control programs.

Adolescent↗
PubMed2006

Population-based mammography screening and breast cancer incidence in New South Wales, Australia.

OBJECTIVE: To analyse breast cancer incidence trends in New South Wales (NSW), Australia, in relation to population-based mammography screening targeting women aged 50 to 69 years. METHODS: Trends in age-specific incidence of invasive breast cancers in NSW women aged > or = 40 years were examined in relation to mammography screening rates and screening cancer detection rates. RESULTS: Incidence of invasive breast cancer in NSW women increased in all age-groups over 1972 to 2002. The incidence trend for women aged 50 to 69 years showed that the steepest rise was associated with increased participation in population-based mammography screening, which was implemented from 1988 and achieved state-wide coverage in 1995. The elevated incidence of invasive cancer significantly exceeded pre-screening levels, and persisted after rates of initial screens declined. This elevated incidence was sustained by the contribution of cancers diagnosed through subsequent screening, and resulted from increased cancer detection rates in subsequent screens. CONCLUSIONS: The recent increase in invasive breast cancer incidence in NSW is associated with mammography screening, and occurred mostly in the target age-group women. Persistence of higher incidence after 1994 was not explicable by inflation of cancer incidence due to detection of prevalent screen cases, but was associated with a trend of increased cancer detection rates in subsequent screening rounds, probably consequent to quality improvements in mammography screening diagnosis.

Aged↗
PubMed2006

Assessment of distress and burden in Australian private psychiatric inpatients.

OBJECTIVES: The study aimed to examine (i) the extent of the objective and subjective burden of care experienced by carers of individuals attending Australian private psychiatric hospitals, (ii) the degree to which a carer's distress was influenced by the patient's symptoms and the burden of care experienced. METHODS: A group of 135 inpatient-carer dyads, for inpatients who attended three Australian private psychiatric clinics, completed measures of distress (Depression Anxiety Stress Scales) and caregiver burden (Burden Assessment Scale; BAS) during an inpatient admission to a private psychiatric hospital. RESULTS: The level of burden reported by carers was comparable with overseas data. Factor analysis was used to identify the key dimensions of the BAS. The chief concerns of carers related to worries about the patient and disruption to activities. CONCLUSION: The burden experienced by carers needs to be recognized and addressed to ensure that they are able to continue to provide the care and support required by psychiatric inpatients. Present data are discussed in terms of the best way to support the carers of psychiatric inpatients.

Affect↗
PubMed2006

Recruitment to mammography screening: a randomised trial and meta-analysis of invitation letters and telephone calls.

OBJECTIVES: To determine the effectiveness of three recruitment strategies to encourage women to attend for an initial mammography screen, and to compare results with similar service studies. Interventions were: (1) an invitation letter; (2) two invitation letters; and (3) an invitation letter plus a follow-up telephone call. METHODS: All women aged 50-54 years in two BreastScreen New South Wales (BSNSW) Screening and Assessment Service catchment areas (n=3,144) were recruited from the Australian Electoral Roll and randomised to the four groups. Response rates for each intervention were compared relative to standard practice (one invitation letter) at 12-weeks follow-up. Marginal cost-effectiveness for each condition was calculated. Other similar randomised trials were also meta-analysed. RESULTS: The screening rate for two letters was 8.5% (OR=1.61, 95% CI 1.08-2.40) and 7.8% (OR=1.46, 95% CI 0.97-2.18) for one letter plus a telephone call, compared with 5.5% for standard practice (one letter) (OR=1.00). The response rate in the one letter plus a phone call group was 13.3% (OR=2.65, 95% CI 1.76-4.00) for women where a phone number was located. CONCLUSION: Initial screening rates after a 12-week follow-up were significantly higher in the women receiving a second invitation letter, compared with standard practice (one letter). Marginal cost-effectiveness favoured the two-letter approach. IMPLICATIONS: A follow-up invitation letter is more cost-effective than one invitation letter plus a follow-up telephone call in the BSNSW program. However, an invitation letter plus follow-up phone call is more cost-effective in recruiting women to BSNSW only if a phone number is located.

Correspondence as Topic↗
PubMed2005

Cancer detection and mammogram volume of radiologists in a population-based screening programme.

This study investigates the relationship between the number of screening mammograms read by radiologists and the screening breast cancer detection rate. Cancer detection rates for incident screens (all women aged 40 years) were compared by increasing categories of reader volume using Poisson regression. Data from New South Wales (NSW) for a 2 year period (2000-2001) were obtained from the BreastScreen NSW programme. Cancer detection rates increased with the number of mammograms read in the programme, reaching a plateau of approximately 40 per 10,000 after 1375 mammograms per year. No significant differences in cancer detection were evident above 875 mammograms (compared to below 875 mammograms) per year (RR=0.79, 95% CI 0.63-0.99).

Adult↗
PubMed2005

Mental health and socio-economic variations in Australian suicide.

This paper investigates the relationship between suicide rates and prevalence of mental disorder and suicide attempts, across socio-economic status (SES) groups based on area of residence. Australian suicide data (1996-1998) were analysed in conjunction with area-based prevalences of mental disorder derived from the National Survey of Mental Health and Well-Being (1997). Poisson regression models of suicide risk included age, quintile of area-based SES, urban-rural residence, and country of birth (COB), with males and females analysed separately. Analysis focussed on the association between suicide and prevalences of (ICD-10) affective disorders, anxiety disorders, substance use disorders and suicide attempts by SES group. Prevalences of other psychiatric symptomatology, substance use problems, health service utilisation, stressful life-events and personality were also investigated. Significant increasing gradients were evident from high to low SES groups for prevalences of affective disorders, anxiety disorders (females only), and substance use disorders (males only); sub-threshold drug and alcohol problems and depression; and suicide attempts and suicide (males only). Prevalences of mental disorder, other sub-threshold mental health items and suicide attempts were significantly associated with suicide, but in most cases associations were reduced in magnitude and became statistically non-significant after adjustment for COB, urban-rural residence, and SES. For male suicide the relative risk (RR) in the lowest SES group compared to the highest was 1.40 (95% CI 1.29-1.52, p<0.001) for all ages, and 1.46 (95% CI 1.27-1.67, p<0.001) for male youth (20-34 years). This relationship was not substantially modified in males when regression models included prevalences of affective disorders, and other selected mental health variables and demographic factors. From a population perspective, SES remained significantly associated with suicide after controlling for the prevalence of mental disorders and other psychiatric symptomatology. Mental conditions and previous suicidal behaviour may play an intermediary role between SES and suicide, but this study suggests that an independent relationship between suicide and SES also exists.

Adult↗
PubMed2005

Increased quantitative proteome coverage with (13)C/(12)C-based, acid-cleavable isotope-coded affinity tag reagent and modified data acquisition scheme.

Quantitative protein profiling using the isotope-coded affinity tag (ICAT) method and tandem mass spectrometry (MS) enables the pair-wise comparison of protein expression levels in biological samples. A new version of the ICAT reagent with an acid-cleavable bond, which allows removal of the biotin moiety prior to MS and which utilizes (13)C substitution for (12)C in the heavy-ICAT reagent rather than (2)H (for (1)H) as in the original reagent, was investigated. We developed and validated an MS data acquisition strategy using this new reagent that results in an increased number of protein identifications per experiment, without losing the accuracy of protein quantification. This was achieved by following a single survey (precursor) ion scan and serial collision induced dissociations (CIDs) of four different precursor ions observed in the prior survey scan. This strategy is common to many high-performance liquid chromatography-electrospray ionization (HPLC-ESI)-MS shotgun proteomic strategies, but heretofore not to ICAT experiments. This advance is possible because the new ICAT reagent uses (13)C as the "heavy" element rather than (2)H, thus, eliminating the slight delay in retention time of ICAT-labeled "light" peptides on a C18-based HPLC separation that occurs with (2)H and (1)H. Analyses using this new scheme of an ICAT-labeled trypsin-digested six protein mixture as well as a tryptic digest of a total yeast lysate, indicated that about two times more proteins were identified in a single analysis, and that there was no loss in accuracy of quantification.

Carbon↗
PubMed2005

Mammography screening participation: effects of a media campaign targeting Italian-speaking women.

OBJECTIVES: To evaluate the effect of a radio and newspaper campaign encouraging Italian-speaking women aged 50-69 years to attend a population-based mammography screening program. METHODS: A series of radio scripts and newspaper advertisements ran weekly in the Italian-language media over two, four-week periods. Monthly mammography screens were analysed to determine if numbers of Italian-speaking women in the program increased during the two campaign periods, using interrupted time series regression analysis. A survey of Italian-speaking women attending BreastScreen NSW during the campaign period (n=240) investigated whether individuals had heard or seen the advertisements. RESULTS: There was no statistically significant difference in the number of initial or subsequent mammograms in Italian-speaking women between the campaign periods and the period prior to (or after) the campaign. Twenty per cent of respondents cited the Italian media campaign as a prompt to attend. Fifty per cent had heard the radio ad and 30% had seen the newspaper ad encouraging Italian-speaking women to attend BSNSW. The most common prompt to attend was the BSNSW invitation letter, followed by information or recommendation from a GP. CONCLUSION: Radio and newspaper advertisements developed for the Italian community did not significantly increase attendance to BSNSW. IMPLICATIONS: Measures of program effectiveness based on self-report may not correspond to aggregate screening behaviour. The development of the media campaign in conjunction with the Italian community, and the provision of appropriate levels of resourcing, did not ensure the media campaign's success.

Age Distribution↗
PubMed2005

Comparison of the validity and reliability of two image classification systems for the assessment of mammogram quality.

OBJECTIVE: To compare the reliability and validity of two classification systems used to evaluate the quality of mammograms: PGMI ('perfect', 'good', 'moderate' and 'inadequate') and EAR ('excellent', 'acceptable' and 'repeat'). SETTING: New South Wales (Australia) population-based mammography screening programme (BreastScreen NSW). METHODS: Thirty sets of mammograms were rated by 21 radiographers and an expert panel. PGMI and EAR criteria were used to assign ratings to the medio-lateral oblique (MLO) and cranio-caudal (CC) views for each set of films. Inter-observer reliability and criterion validity (compared with expert panel ratings) were assessed using mean weighted observed agreement and kappa statistics. RESULTS: Reliability: Kappa values for both classification systems were low (0.01-0.17). PGMI produced significantly higher values than EAR. Agreement between raters was higher using PGMI than EAR for the MLO view (77% versus 74%, P < 0.05), but was similar for the CC view. Dichotomized ratings ('acceptable' or 'needs repeating') did not improve reliability estimates. VALIDITY: Kappa values between raters and the reference standard were low for both classification systems (0.05-0.15). Agreement between raters and the reference standard was higher using PGMI than EAR for the MLO view (74% versus 63%), but was similar for the CC view. Dichotomized ratings of the MLO view showed slightly higher observer agreement. CONCLUSIONS: Both PGMI and EAR have poor reliability and validity in evaluating mammogram quality. EAR is not a suitable alternative to PGMI, which must be improved if it is to be useful.

Breast Neoplasms↗
PubMed2005

Social and psychiatric influences on urban-rural differentials in Australian suicide.

The purpose of this study was to investigate urban-rural differentials in Australian suicide rates, and to examine influences that previously have remained largely speculative. Suicide rates for males (all ages and young adults) were significantly higher in rural areas compared to urban areas. Urban-rural suicide rate differences in males were rendered nonsignificant after adjustment for migrant and area socioeconomic status. Adjusting for mental disorder prevalence, in addition to migrant status, reduced the excess suicide risk in rural areas; the excess was reduced further with addition of mental health service utilization. The implications of this study are that socioeconomic circumstances in rural populations contribute to higher male suicide rates compared to urban areas, but these conditions may be partly mediated by mental disorder prevalence and mental health service utilization.

Adolescent↗
PubMed2004

Socio-economic differentials in mental disorders and suicide attempts in Australia.

BACKGROUND: Responses to mental disorders usually focus on treatment; socio-economic conditions are less likely to be considered. AIMS: To examine social determinants of mental disorders and attempted suicide in Australia. METHOD: Data from the 1997 Australian National Survey of Mental Health and Wellbeing (n=10 641) were used to estimate associations between socio-economic status, mental disorders and attempted suicide. Logistic regression was used to adjust for age, urban/rural residence and country of birth. Socio-economic status differentials in suicide attempts were also adjusted for mental disorders. RESULTS: Significant increasing gradients from high to low levels of education and occupational status (employed) were evident for affective disorders and anxiety disorders in both men and women and for substance use disorders in men. Similar gradients were found for suicide attempts, which decreased after adjusting for mental disorders, but remained significant in the working-age employed. CONCLUSIONS: These findings suggest social causation of mental disorders and suicide attempts, and the need for social and economic responses beyond provision of mental health services.

Adult↗
PubMed2003

Predictors of non-attendance from BreastScreen NSW in women who report current mammography screening.

OBJECTIVE: To identify among self-reported current screeners: (1) predictors of never attendance at BreastScreen NSW (BSNSW); (2) predictors of late or lapsed attendance to BSNSW (attendance to alternative providers). METHODS: Random samples of women aged 50-69 years were selected from the BSNSW database and NSW electoral roll as: current attenders to BSNSW (<27 months since last screen); late or lapsed attenders to BSNSW (>27 months since last screen); or women who had never attended BSNSW. The response rate was 71% (3,104) for a telephone interview that asked questions concerning demographics, medical status and health service usage, and opinions and behaviours related to mammography. RESULTS: Never attendance at BSNSW was predicted by higher income, advice from a doctor or nurse to have their last mammogram, recent clinical breast examination and belief that a referral letter is necessary. Late or lapsed attendance to BSNSW (and attendance to alternate providers) was associated with higher education, health insurance coverage, recent clinical breast examination and a family history of breast cancer. CONCLUSIONS: Currently screened women who do not attend BSNSW, or who are late or lapsed for a mammogram, appear to be influenced by referral patterns of their health care providers and their higher socio-economic status. IMPLICATIONS: BSNSW should be promoted to eligible women and general practitioners as a specialty mammography screening service that does not require a referral.

Aged↗
PubMed2002

Suicide differentials in Australian males and females by various measures of socio-economic status, 1994-98.

OBJECTIVES: To investigate Australian suicide differentials in males and females by three area-based measures of socio-economic status (SES). METHODS: Suicide data for 1994-98 were used to investigate area-based gradients of SES for the Index of Relative Socio-Economic Disadvantage (IRSED) (an overall measure of SES), the Index of Economic Resources (IER), and the Index of Education and Occupation (IEO), using Poisson regression models adjusting for age, country-of-birth and urban-rural residence. RESULTS: After adjusting for age, country-of-birth and urban-rural residence, significant increasing linear trends in suicide risk from high to low quintiles of SES were evident in males for the IRSED (an average multiplicative increase in suicide risk of 8% per quintile), IER (9% increase) and IEO (5% increase). For females, there was no evident SES gradient for the IRSED after adjusting for age, country-of-birth and urban-rural residence, but a significant positive linear trend from high to low quintiles of SES was found for the IER (6% increase per quintile). A significant decreasing linear trend (increasing suicide risk with increasing SES) was evident for the IEO (30% per quintle). CONCLUSION: Male suicide is positively associated with all three measures of SES examined. Female suicide is significantly associated with the IER (positive association) and IEO (negative), and because of this is not associated with the overall measure of SES. These findings partly explain why female suicide has been found to be poorly correlated with area-based measures of SES. IMPLICATIONS: Specific components of area-based socio-economic status provide a clearer picture of socio-economic suicide differentials in Australian females, with implications for population-based preventive strategies.

Adolescent↗