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Biomedical subjects

D R English

Publications and source records attributed to D R English.

At least 19 recordsLinked to original sources
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↗
PubMed1991

Principles behind practice. 7. Case-control studies.

The case-control study is often a very simple, cheap and quick way to test the hypothesis that a particular factor causes a disease or that a particular treatment is helping patients who receive it. There also seems to be an inherent logic in comparing patients and well people to see how they differed in the past, or in comparing those who did and did not survive a certain illness to see how their treatment differed. Despite these appealing features, the case-control approach is subject to a number of pitfalls. These can usually be avoided by an appropriately designed study, and by careful collection and analysis of the data. Even so, the results of a case-control study are a lower order of evidence than those produced from a properly conducted randomised controlled trial.

Bias↗
PubMed1991

Pigmentary and cutaneous risk factors for non-melanocytic skin cancer--a case-control study.

The roles of ethnic origin, pigmentary traits, sun sensitivity and other cutaneous characteristics as risk factors for basal-cell carcinoma (BCC) and squamous-cell carcinoma (SCC) were examined in a case-control study of prevalent and incident cases of histopathologically confirmed skin cancers. Two hundred and twenty six confirmed cases of BCC, 45 of SCC and 1,015 controls with no lesions were identified in a population-based survey of skin cancer in 1987 in Geraldton, Western Australia. The risk of both cancers was higher in native-born Australians than in migrants. The risk of BCC decreased with increasing age at arrival in Australia. Southern European ancestry was strongly protective against BCC (for any southern European grandparents) and SCC (no case of SCC had any grandparents of southern European origin). Inability to tan was the strongest pigmentary risk factor for both BCC and SCC. Among factors that incorporated a measure of sun exposure as well as sun sensitivity, freckling on the arm in childhood was important for both cancers, the number of moles on the back was important for BCC, and forearm skin colour and having a permanent colour difference between the neck and adjacent protected areas were important for SCC. Among measures of sun damage to the skin, solar elastosis of the neck was a strong risk factor for both BCC and SCC, loss of fine texture of the skin of the back of the hands (as measured by cutaneous microtopography) was important for BCC and telangiectasia of the face for SCC. When all important variables for each cancer were examined together in a single model with age, sex, migrant status or age at arrival in Australia, and ethnicity, in ability to tan, solar elastosis of the neck, and the number of moles on the back were independently significant risk factors for BCC and solar elastosis of the neck and having a permanent colour difference between the neck and adjacent protected areas were independently significant risk factors for SCC. The effects of age at arrival or migrant status and ethnic origin remained important in the models incorporating these factors. A history of ever having acne and a history of warts were protective for BCC and a history of acne was protective for SCC.

Adult↗
PubMed1990

Skin cancer in Geraldton, Western Australia: a survey of incidence and prevalence.

A survey of the incidence and prevalence of non-melanocytic skin cancer in Geraldton, Western Australia, was undertaken in November 1987. All residents aged 40 to 64 years whose names were on the electoral roll on August 1, 1987 were invited to undergo a whole-body skin examination by a dermatologist. When a skin cancer was suspected, participants were referred for treatment to their usual medical practitioner. Subjects were asked to recall incident skin cancers over the preceding two years, and medical records were searched for confirmatory evidence. Histological confirmation of all lesions, both prevalent and incident, was sought and sections were obtained for a standardized review. The prevalence of confirmed non-melanocytic skin cancer in those aged 40 to 64 years was 7.0% in men and 4.7% in women. The prevalence of basal-cell carcinoma (BCC) was 6.5% in men and 4.5% in women while the prevalence of squamous-cell carcinoma (SCC) was 1.2% in men and 0.3% in women. The estimated incidence rate of non-melanocytic skin cancer in this age group was 1560 per 100,000 person-years. The estimated incidence rate of BCC in men was 1335 per 100,000 person-years, and in women 817 per 100,000, while in men the estimated incidence rate of SCC was 890 per 100,000 person-years, and in women it was 289 per 100,000 person-years.

Adult↗
PubMed1989

A review of the effects of random measurement error on relative risk estimates in epidemiological studies.

Many articles in the recent epidemiological literature have discussed the effects of random error and misclassification on effect estimation, but many of these have been unclear and hard to follow. This paper reviews and interprets many of these and summarizes the use of the correlation coefficient in assessing the likely effect of measurement error on relative risk estimates for variables that are either continuous or ordered. A table of expected values of relative risks (RRs) calculated in different ways for different levels of random error is presented and the typically large expected attenuation in RR values is shown. The recommendation of taking repeated or multiple measurements whenever possible is endorsed.

Confounding Factors, Epidemiologic↗
PubMed1989

Determinants of blood pressure in childhood and adolescence.

Relationships between blood pressure and dietary factors were investigated in 434 boys and 450 girls aged 9 years. Dietary data were obtained from a food-frequency questionnaire which was completed by parents. This was used to estimate daily energy intake and the intake of 14 nutrients considered likely to influence blood pressure. Blood pressure was tested for relationships to absolute and calorie-adjusted intakes of each nutrient after adjustment for age, weight, height, socio-economic status and the month of examination. Ambient temperature was the most important determinant of blood pressure, an increase of 10 degrees C being associated with a 6-7 mmHg fall in blood pressure. Diastolic blood pressure in boys was negatively related to energy intake and to calorie-adjusted fibre intake. Mean adjusted diastolic blood pressure in boys in the top fibre intake quartile was 2.5 mmHg lower than that in the lowest quartile. Systolic blood pressure in girls was negatively related to calorie-adjusted intakes of protein. There were no relationships between blood pressure and calorie-adjusted intakes of fats, carbohydrates, sodium, potassium, calcium or magnesium.

Adolescent↗
PubMed1989

The contribution of mortality statistics to the study of multiple sclerosis in Australia.

Mortality statistics provided a valuable source of support for data obtained from prevalence surveys of multiple sclerosis in Australia. Firstly, multiple sclerosis mortality data for the decade 1971-80 in the States of Australia confirmed the relationship between increasing disease frequency and increasing south latitude shown by State and regional point prevalence surveys based on the national census day 30 June 1981. Secondly, a comparison with mortality data from the decade 1950-59 showed that in most States there had been a substantial fall in multiple sclerosis mortality in the more recent decade and this was clearly an important contributing factor to the rise in prevalence noted between the morbidity surveys of 1961 and 1981. Thirdly, multiple sclerosis mortality in the UK-born migrant population dying in Australia was found to be similar to that of the Australian-born population and very much lower than that found in the UK. This observation corroborated evidence from the 1981 morbidity surveys and suggested that migration from the UK to Australia may lower the risk of developing multiple sclerosis either through a reduction in disease incidence or the operation of environmental factors curbing disease expression.

Australia↗
PubMed1988

Identifying people at high risk of cutaneous malignant melanoma: results from a case-control study in Western Australia.

To assess whether screening people at high risk of malignant melanoma would be effective in reducing the mortality from the disease data from 400 case-control pairs in a study of cutaneous malignant melanoma conducted in Western Australia during 1980-1 were used to predict the risk of melanoma in the remaining 111 pairs. All variables previously shown to be associated with a decrease or increase in the incidence of melanoma were considered for inclusion in a single conditional logistic regression model of the incidence of melanoma in the randomly chosen subset of 400 case-control pairs. Five of these variables--number of raised naevi on the arms, arrival in Australia before 10 years of age, history of non-melanocytic skin cancer, time spent outdoors in summer from the age of 10 to 24, and family history of melanoma--provided good discrimination between patients and controls in this sample and the 111 other case-control pairs. Among the 222 subjects in these other case-control pairs a group defined as being at high risk of melanoma by a risk score derived from these five variables contained 60 (54%) of the patients with melanoma but only 18 (16%) of the controls. These data suggest that in Western Australia more than half of all new patients with melanoma arise in an identifiable subpopulation constituting less than one fifth of the whole population. Identifying this subpopulation and screening it regularly for cutaneous malignant melanoma could be cost effective in reducing mortality from this disease.

Adolescent↗
PubMed1988

Diet and blood pressure in 9-year-old Australian children.

Relationships between blood pressure and dietary factors were investigated in 884 9-y-old Australian children. Data on usual diet were obtained from a food frequency questionnaire completed by parents. The data were used to estimate daily energy intake and intakes of 14 nutrients considered to have some potential for influencing blood pressure. Systolic and diastolic blood pressure were tested for relationships with absolute intakes and calorie-adjusted intakes of each nutrient after adjustment for potential confounders. Diastolic pressure in boys was negatively related to energy intake and to calorie-adjusted fiber intake. Mean adjusted diastolic pressure in boys in the top fiber-intake quartile was 2.5 mm Hg lower than that in the bottom fiber-intake quartile. Systolic pressure in girls was negatively related to calorie-adjusted intakes of protein and cholesterol. There were no detectable relationships between blood pressure and calorie-adjusted intakes of fats, carbohydrates, sodium, potassium, calcium, or magnesium.

Australia↗
PubMed1988

Incidence and outcome of multiple myeloma in Western Australia, 1960 to 1984.

All patients diagnosed with multiple myeloma in Western Australia have been registered since 1960; 337 men and 280 women were registered in the period 1960-84. During this period there was a 25% increase in incidence. Age adjusted incidence rates rose from 2.34 per 100,000 person years in men and 1.64 in women during the decade 1960-69 to 2.95 in men and 1.92 in women in 1980-84. Overall, the incidence was 1.36 times higher in men than in women (95% confidence interval 1.16-1.59). Survival from multiple myeloma improved substantially during the period. In 1960-69, median survival for both sexes was six months, in 1970-79 it was 19 months, and in 1980-84 median survival in men was 43 months while in women it was at least five years.

Agricultural Workers' Diseases↗
PubMed1987

Pineal neoplasms and third-ventricular teratomas in Niigata (Japan) and Western Australia. A comparative study of their incidence and clinicopathological features.

It is claimed that Japan has the highest incidence of pineal neoplasms in the world. To test this hypothesis, we reviewed all pineal neoplasms and third-ventricular teratomas that were diagnosed histopathologically and treated neurosurgically over 10 years (1975-1984) in Niigata City, Japan (12 patients) and in Perth, Western Australia (9 patients). The age-standardized incidence rates per million person-years were 0.61 for Niigata and 0.70 for Western Australia; thus, the contention that Japan has the highest incidence in the world of pineal neoplasms is not confirmed.

Adolescent↗
PubMed1987

Melanoma in Western Australia in 1980-81: incidence and characteristics of histological types.

All cutaneous malignant melanomas diagnosed in Western Australia in 1980-81 were reviewed and classified according to histological type (i.e., superficial spreading melanoma, Hutchinson's melanotic freckle melanoma (lentigo maligna melanoma), nodular melanoma and melanoma of unclassifiable type). The most common invasive melanoma was superficial spreading melanoma with an incidence rate of 14.3 per 100,000 person-years in females and 9.0 in males. It most commonly affected the trunk in males and the lower limbs in females and showed a peak incidence in middle life. Invasive Hutchinson's melanotic freckle melanoma was much less common than invasive superficial spreading melanoma (1.8 per 100,000 person-years in both sexes), occurred most commonly on the head and neck and increased progressively in incidence with age. Nodular melanomas were more frequent in men (4.5 per 100,000 person-years) than women (2.0). They were thicker than other types of invasive melanomas, showed more mitotic activity and had less evidence of regression. Their site distribution was similar to that of superficial spreading melanoma. In women the pattern of incidence with age was also similar to that of superficial spreading melanoma. In men it was more like that of Hutchinson's melanotic freckle melanoma. Melanomas of unclassifiable type did not have distinctive epidemiological features common to both sexes, although the trunk was the site most commonly affected in both men and women. With some exceptions the patterns of occurrence of in-situ lesions were similar to those of the corresponding invasive lesions. Benign melanocytic naevi were found less often in association with Hutchinson's melanotic freckle (melanoma) (6%) and nodular melanoma (9%) than with superficial spreading melanoma (22%) or melanoma of unclassifiable type (34%).

Adolescent↗
PubMed1987

Environmental temperature and blood pressure in 9-year-old Australian children.

Relationships between blood pressure (BP) and environmental temperature were investigated as part of a broader study of constitutional and environmental determinants of BP in a sample of 1037 9-year-old Australian children. A Dinamap semi-automatic device was used to obtain three BP readings for each child. Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) differed according to month of examination, with higher levels in the colder months. Negative relationships were observed between BP and temperature on the measurement day; computed regression equations indicated that a rise in maximum daily temperature of 10 degrees C was associated with falls of 5-7 mmHg in SBP and DBP. The relationships were independent of age, weight, height, socio-economic status and heart rate (HR). The results emphasize the importance of taking environmental temperatures into account in epidemiological studies of BP.

Anthropometry↗
PubMed1986

The dysplastic naevus syndrome in patients with cutaneous malignant melanoma in Western Australia.

One hundred and three patients with cutaneous malignant melanoma responded to an invitation to attend a dermatology outpatient clinic. All patients with a family history of melanoma, a history of multiple melanomas, or histological evidence of a dysplastic naevus that was associated with their melanoma were invited. A random sample of other patients with cutaneous malignant melanoma was also invited to attend. First-degree relatives of patients with the dysplastic naevus syndrome (DNS) were invited for a similar examination. DNS was found in 27% of the patients with a family history of melanoma, multiple melanomas, or histological evidence of a dysplastic naevus in association with their melanoma, and in 6% of the remaining patients who were selected at random. DNS was estimated to be present in 12.8% of 17- to 55-year-old patients with cutaneous malignant melanoma in the Perth region, while familial DNS was present in 4.5%. Patients with melanomas with DNS were more likely to be young men and to have numerous naevi, particularly on the lateral surfaces of the arms, shoulders and trunk, than were patients with melanomas without the syndrome.

Adolescent↗
PubMed1986

Prevalence of and risk factors for cerebral palsy in a total population cohort of low-birthweight (less than 2000g) infants.

This paper reports a total population-based cohort study of over 500 surviving children born in 1974, 1975 and 1976, who were identified as having been a low birthweight (less than 200g). The prevalence of cerebral palsy (CP) diagnosed by age six years was compared for groups who had various antenatal and perinatal attributes. For children who had weighed less than 2000g the CP prevalence was 3.6 per cent for those less than 1500g and 4.3 per cent for those between 1500g and 1999g. The main factors predicting CP in the low-birthweight infants were measures of neonatal asphyxia, but the majority of children with CP had no extra adverse perinatal risk-factors compared to non-CP survivors, were not asphyxiated and had not received high-level neonatal intensive care. The CP rates were not significantly different between any other available antenatal, perinatal or sociodemographic risk-factor groups. It is suggested, therefore, that CP is not a good index of the impact of neonatal intensive care, and that research should now concentrate on elucidating the genetic, developmental and antenatal risk-factors for the various CP syndromes.

Asphyxia↗