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Biomedical subjects

C D Holman

Publications and source records attributed to C D Holman.

At least 19 recordsLinked to original sources
PubMed1996

Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations.

OBJECTIVE: To compare the National Health and Medical Research Council (NHMRC) recommendations on responsible, hazardous and harmful alcohol intake with their effects on all-cause mortality in men and women and on the occurrence of 10 specific neoplastic, cardiovascular and alimentary diseases. DESIGN: Meta-analyses of relative risks of mortality in relation to usual level of alcohol intake pooled from 16 cohort studies (mostly of adults over 35 years), and alcohol and selected conditions from a further 132 epidemiological studies. Results reported by authors were assigned to sex-specific exposure categories defined by the NHMRC based on median alcohol intakes. Pooled estimates of relative risk were calculated using precision-based weighting. SETTING: The assessment was part of comprehensive meta-analysis of epidemiological research undertaken for the National Drug Strategy. RESULTS: Relative risk of all-cause mortality in male drinkers compared with abstainers fell to 0.84 at 1.0-1.9 standard drinks per day, returned to 1.01 by 3.0-3.9 drinks, and increased to 1.37 at six or more drinks. In female drinkers the lowest relative risk (of 0.88) was at 0-0.9 drinks per day, and by 2.0-2.9 drinks the risk exceeded that in abstainers by 1.13; at six drinks the relative risk was 1.58. Based on NHMRC categories, the relative risks of mortality were 0.93 (0.93-0.94) in responsible drinkers, 1.24 (1.22-1.27) in hazardous drinkers and 1.37 (1.35-1.49) in harmful drinkers. Risk of cancers of the oropharynx, oesophagus, liver, larynx and female breast and of cirrhosis of the liver increased with increasing alcohol intake level. CONCLUSIONS: A pattern of usual alcohol intake consistent with the NHMRC recommendations will confer a mortality risk similar to or less than that observed in abstainers. The biologically effective dose of alcohol on mortality in women is approximately two standard drinks per day less than in men. Our validation is most reliable for drinkers aged 35 years or older.

Adult↗
PubMed1996

Ought low alcohol intake to be promoted for health reasons?

There is increasingly widespread acceptance that alcohol taken in moderation by the population aged 35 years or older reduces the risks of ischaemic heart disease and all-cause mortality. Ten causal criteria are used to evaluate the scientific evidence for a protective effect of low alcohol intake on ischaemic heart disease. Inferences for public policy are then assessed using the principles of beneficence, non-maleficence, justice and autonomy to support a framework of nine ethical considerations: intervention versus causation; effect modification by gender, smoking, biogenetic and other factors; inappropriate adoption of recommendations; competing hazards between atherosclerotic disease and cancer; opportunity cost; equity of access; the value system used to judge outcomes; the degree of social influence warranted; and consent and responsibility. We conclude that in the absence of more adequate scientific knowledge and informed community debate it is unethical to promote low alcohol intake as a preventive health measure.

Alcohol Drinking↗
PubMed1995

Misclassification of social disadvantage based on geographical areas: comparison of postcode and collector's district analyses.

BACKGROUND: Analysis of socioeconomic status (SES), defined on the basis of geographical area, will always be subject to misclassification of individuals. We studied the relationship between SES and selected health-related measures when SES was defined firstly on the basis of postcode and secondly on the basis of the smaller spatial area of collector's district (CD). METHOD: A Census population of 1.4 million was used to investigate the misclassification of individuals to SES group using postcode as opposed to CD. A field survey of 1000 respondents and a mortality register of 1756 deaths were used to compare the relationship between SES and certain outcome variables, when SES group was assigned using postcode and CD. Misclassification probability matrices were used to try to adjust the postcode-based results to approximate CD-based results. RESULTS: The Census data showed that nearly 50% of residents were misclassified into SES groups by the postcode-based system compared with a CD-based system. In comparing the most socially disadvantaged group with the least disadvantaged group, the postcode analysis underestimated the absolute effects of SES by 58% for the increased prevalence of smoking, by 19% for the reduced prevalence of participation in junior sporting clubs and by 13% for the increased mortality rate at ages 0-64 years. Adjustment of postcode-based results using misclassification matrices proved fruitless due to differential misclassification and technical difficulties. CONCLUSIONS: Misclassification of individuals to SES groups on the basis of postcode has caused an underestimation of the true relationship between SES and health-related measures. A reduction of this misclassification by using smaller spatial areas, such as CD or census enumeration districts, will provide improved validity in estimating the true relationship.

Adolescent↗
PubMed1995

Epidemiological measures of participation in community health promotion projects.

BACKGROUND: The paper is concerned with the use of epidemiological methods to measure the rates at which different strata of a defined population participate in community health promotion projects. The specific aim was to estimate the incidence rates of participation in projects sponsored by the Western Australian Health Promotion Foundation (Healthway), separately for sociodemographic and health-related behavioural subgroups. METHODS: Data were drawn from Healthway sponsorship projects in 1992. Each sport, arts and racing project was associated with promotion of a health message and creation of a health promoting environment. The study used a two-stage sampling design. Thirteen of 57 large sponsorship projects and 30 of 129 small projects were selected. In the second stage, respondents were randomly surveyed from among project participants. A total of 4060 respondents aged > or = 10 years was sampled from the 43 selected projects. Population-based incident participants were estimated and were related to person-years at risk. RESULTS: The total participation rate was 4.01 per person-year. The rate was very high at ages 10-14 years and thereafter declined with increasing age. Compared with the least socially disadvantaged 25% of population, the participation rate fell by around one-third in the medium and high disadvantage groups, but exceeded the baseline by a ratio of 1.85 (95% confidence interval: 1.57-2.18) in the most disadvantaged 10% of population. The effect was most pronounced at ages 10-19 years. Participation was higher in those who smoked, drank alcohol unsafely, reported sunburn and reported low consumption of fruit and vegetables. However, participation was reduced in people who were sedentary. CONCLUSIONS: Epidemiological methods can be used to evaluate the distribution of participation of a population in community health promotion projects. The Western Australian Health Promotion Foundation has been successful in reaching disadvantaged youth.

Adolescent↗
PubMed1995

An improved aetiologic fraction for alcohol-caused mortality.

A method is proposed for estimation of alcohol-caused mortality in which the aetiologic fraction of deaths is derived from an exposure contrast between the 'unsafe' drinker and 'safe' drinker; not between the drinker and the nondrinker. The method is consistent with the objectives of public health intervention in the alcohol education field. The 'safe' drinker is the reference exposure category and aetiologic fractions are obtained for the single categories of a multiple-level exposure scale, using separate relative risks for the 'unsafe' drinker and the nondrinker. Preliminary application of the method to Australian data yields an estimate of the number of deaths caused by misuse of alcohol that is larger than those obtained under the old conceptual model. Thus, the public health importance of unsafe alcohol consumption has been underrepresented.

Alcohol Drinking↗
PubMed1993

Cervical cancer screening in Western Australia in 1992: progress since 1983.

OBJECTIVES: To estimate the rate of cervical cancer screening in Western Australia in 1992, and any variation by age, place of residence, and socio-economic status; and to determine the proportion of smears taken by different service providers. DESIGN: Descriptive study; collection of data from Papanicolaou (Pap) smear request forms during one calendar month. SETTING: All 13 cytology laboratories in Western Australia. PARTICIPANTS: 15,767 women in Western Australia aged 15 years and over having a cervical smear in March 1992. MAIN OUTCOME MEASURES: Rates by age of cervical cancer screening per 1000 woman-years; age-standardised rate ratios for socioeconomic status and place of residence; proportion of smears taken by male and female service providers. RESULTS: The estimated rate of Pap smears at ages 15 years and over was 303 smears per 1000 woman-years, an increase of 44% over a similar survey in 1983. The greatest increases were among women aged 50 years and over, but their rates were still well below that equivalent to three-yearly smears. Differences in the rate of screening by socioeconomic status (defined by residential postcode) were not statistically significant. The age-standardised rate ratio comparing country women with women in the Perth metropolitan area was 0.91 (95% confidence interval 0.87-0.94). General practitioners took 78% of the smears, and at least 46% of all smears were taken by female service providers. Almost all the increase in the screening rate since 1983 could be attributed to an increase in the rate of smears per 1000 woman-years taken by female general practitioners. CONCLUSION: While there have been marked improvements in the rates of cervical screening in Western Australia over the past nine years, there are still major deficiencies in the screening coverage of women aged 50 years and over.

Adolescent↗
PubMed1992

The effects of surgical treatment on survival and local recurrence of cutaneous malignant melanoma.

All patients with a diagnosis of cutaneous malignant melanoma (CMM) in Western Australia from 1980 to 1981 were observed for up to 6 years to determine vital status and to detect the development of local recurrences of the primary lesion. Approximately 35% of all patients had their tumors excised with surgical margins of less than 1 cm. When compared with patients whose tumors were excised with margins of at least 2 cm, the fatality rate in those with narrow margins was slightly less (rate ratio, 0.60; 95% confidence interval [CI], 0.20% to 1.80% for margins of 5 to 9 mm; rate ratio, 0.69; 95% CI, 0.26% to 1.87% for margins of 1 to 4 mm); however, this difference could have been caused by chance alone. The risk of local recurrence within 5 years after diagnosis was 2% (95% CI, 1% to 4%). The risk was strongly related to age and tumor thickness, but did not appear to be influenced by the width of excision (greater than 1 cm versus less than 1 cm: rate ratio, 1.03; 95% CI, 0.25% to 4.34%). The apparent lack of effect could be caused by to chance alone because the number of local recurrences was small.

Adult↗
PubMed1991

Survival among patients with clinical stage I cutaneous malignant melanoma diagnosed in Western Australia in 1975/1976 and 1980/1981.

Five-year survival rates were slightly higher for patients with cutaneous malignant melanoma (CMM) diagnosed in Western Australia in 1980/1981 (89% in men and 95% in women) than in those whose melanomas were diagnosed in 1975/1976 (88% in men and 91% in women). The improvement in survival was probably due to a decrease in median tumor thickness from 1.29 mm in 1975/1976 to 0.77 mm in 1980/1981 because tumor thickness was the most important histologic index of prognosis. Tumor cell type and cross-sectional profile were the only other histologic characteristics that independently influenced fatality rates. Prognosis was significantly worse in males than in females and in patients with tumors on the posterior head and neck. Ten-year survival rates of patients whose melanomas were diagnosed in 1975/1976 was 82% in men and 87% in women, indicating that these patients continued to experience some excess mortality up to 10 years after diagnosis. The comparatively small improvement in prognosis in the 5-year period between these two groups suggests that survival might be expected to continue to improve only gradually unless there is a sharp absolute decrease in the number of thick tumors diagnosed.

Adolescent↗
PubMed1990

Dental caries experience in schoolchildren in fluoridated and non-fluoridated communities in Western Australia.

A cross-sectional survey was undertaken in 1987 to measure the difference in caries experience in schoolchildren between a fluoridated (0.8 mg/L F-) and a non-fluoridated region (0.1-0.4 mg/L F-). 3436 children aged 5-15 yr were examined. Children in the non-fluoridated region had a higher caries experience than those in the fluoridated region. Mean differences were 1.06 dfs (95% CI = 0.66 to 1.47, P less than 0.001) and 0.48 DFS (95% CI = 0.23 to 0.72, P less than 0.001). After adjusting for potential confounding factors (fluoride tablet consumption, socioeconomic status, number of fissure-sealed surfaces, and mobility between regions) the relative risk of not being caries-free in the non-fluoridated region compared with the fluoridated region was 1.43 (95% CI = 1.21-1.70, P less than 0.0001) for the primary dentition and 1.39 (95% CI = 1.18-1.63, P less than 0.0001) for the permanent dentition.

Adolescent↗
PubMed1990

Methodology used to monitor and evaluate in vitro fertilization and related procedures in Western Australia, 1983-1987.

A methodology was developed to support a comprehensive health services research project undertaken to monitor and evaluate the practice of in vitro fertilization (IVF) and related procedures, such as GIFT, in Western Australia (WA) from 1983 to 1987. The project included demographic, clinical and economic assessments of the new technology. The study subjects were the 1,240 couples who began IVF treatment between January 1, 1983 and December 30, 1986. Information was collected on all 2,982 treatment cycles commenced by June 30, 1987, and on the 273 births that resulted from these treatment cycles. Where relevant, comparisons were based on information obtained from the Australian Bureau of Statistics (ABS) census, the WA Midwives' Notification System and the WA Hospital Morbidity Data System. The need for long-term follow-up studies of children and participants is identified, as is the need for randomized clinical trials to evaluate more fully the success of the procedures where bilateral tubal blockage is not the indication for the treatment.

Cohort Studies↗
PubMed1989

Population-based epidemiology of human immunodeficiency virus infection in Western Australia. Western Australian AIDS Advisory Committee.

A total of 328 cases of infection with human immunodeficiency virus (HIV) in Western Australia in 1983-1987 was studied with respect to demographic factors, the risk profile, the clinical progression of disease, the utilization of inpatient services and trends in incidence over time. The crude incidence rates were 8.8 cases/100,000 person-years in men and 0.4 cases/100,000 person-years in women. Age-specific rates peaked at 25 to 29 years of age in men. The risk of HIV infection was associated with metropolitan residence, low socioeconomic level, and two specific occupational groups. Homosexual and bisexual men constituted 86% of all cases; the incidence rate of HIV infection in such men was approximately 1000-times higher than was the incidence rate by apparent sexual transmission in heterosexual persons. However, the proportion of cases that occurred in women or that apparently was caused by heterosexual sexual transmission increased from zero in 1983-1984 to 7.5% and 5.4%, respectively, in 1987. After two years of follow-up, 71% of preclinical (category-C) patients had developed signs, symptoms or evidence of immune dysfunction, and 12% of those patients with lymphadenopathy or with other early clinical features of disease (category-B) had progressed to the acquired immunodeficiency syndrome (AIDS). At 21 months of follow-up, the survival rate with AIDS was 9%. Patients with AIDS utilized an average of 68.9 short-stay hospital bed-days per person-year, while category-B patients used 11.5 hospital bed-days per person-year. Notifications of HIV infection increased each year from 1983 to 1986, but fell by 22% in 1987. The latter may have been as a result of chance, a screening artefact or a real reduction in the incidence rate.

Acquired Immunodeficiency Syndrome↗