An unjustified attack on "incidence"?
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Acute Disease↗
Biomedical subjects
D R English
Publications and source records attributed to D R English.
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↗
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↗
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↗
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↗
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↗
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↗
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↗
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↗
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↗
Melanoma in Western Australia 1975-76 to 1980-81: trends in demographic and pathological characteristics.
Trends in incidence rates of cutaneous malignant melanoma in Western Australia from 1975-76 to 1980-1981 have been examined with reference to age, sex, body site, presence or absence of dermal invasion, tumour thickness, histological type, socioeconomic status and occupation. The incidence rates of all melanomas increased from 22.1 to 31.5 per 100,000 person-years in males and from 23.6 to 28.6 in females. In males, the relative annual increase in the incidence of invasive melanoma was 2.2%, and in females it was 5.6%. In-situ melanomas had larger relative increases in incidence (28% per annum in males and 10% in females) and the thickness of invasive lesions decreased between 1975-76 and 1980-81. The relative increase in incidence of invasive melanomas was greatest on the body sites with the highest rates initially--the trunk in males and the lower limbs in females. There was an increase in the proportion of invasive lesions classified as superficial spreading melanoma. The increase in incidence of in situ melanomas was largely restricted to the head and neck in older men of high socioeconomic status resident in Perth. This trend in in-situ melanoma was mainly due to an increase in the recorded incidence of Hutchinson's melanotic freckle. It may have been, in part, an artefact due to increased recognition of Hutchinson's melanotic freckle in this sub-group of the population.
Adolescent↗
The causes of malignant melanoma: results from the West Australian Lions Melanoma Research Project.
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Adolescent↗
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↗
The effect of stopping smoking on blood pressure--a controlled trial.
Epidemiological studies have found evidence of lower blood pressure in smokers and predict an increase in blood pressure after stopping smoking. We have therefore monitored blood pressure change in 33 smokers following entry into a 6-week smoking cessation programme and compared the results to 33 matched controls who continued their normal smoking habits over the same period. Fourteen subjects were successful in quitting smoking for the entire 6 weeks, 13 were unsuccessful and 6 withdrew before completion of the programme. No significant increase in supine or erect systolic or diastolic blood pressure was observed following reduction in or cessation of smoking habit. Complete cessation of smoking was, however, associated with an increase in weight and anxiety levels and a decrease in alcohol consumption. We conclude that although stopping smoking affects several factors which may potentially influence blood pressure, this does not result in any significant change in blood pressure over a 6-week period. Concern that advice to patients to cease smoking may lead to a prompt increase in blood pressure appears unnecessary.
Adult↗
Cutaneous malignant melanoma and fluorescent lighting.
A population-based case-control study of cutaneous malignant melanoma occurring during 1980-81 was conducted in Perth, Western Australia. Three hundred and thirty-seven cases and 349 matched controls were reinterviewed in 1983 with regard to their fluorescent light exposure. The incidence rate of all melanomas was not associated with rate of exposure or cumulative exposure to all fluorescent lights or just those without diffusers. Separate analyses by histogenetic type and, where possible, body site of melanoma showed, in most instances, no consistent association between incidence rate of melanoma and exposure to fluorescent lights without diffusers. Incidence of melanomas of unclassifiable histogenetic type, however, increased with increasing duration of exposure (P-value for trend .02). This association was weaker and the P-value higher (.11) when exposure was considered only in residential rooms and offices, where light fittings are closest to the subject. Adjustment for the effects of total and intermittent sun exposure on melanoma rates did not alter the above trends appreciably.
Adolescent↗
Smoking withdrawal programme: baseline indicators of smoking exposure and biochemical monitoring of successful outcome.
Sixty-four subjects who participated in a smoking withdrawal programme were analysed with respect to the relative usefulness of biochemical and hematological indices of smoking exposure. Plasma thiocyanate was found to be the best biochemical correlate of baseline cigarette consumption when compared to salivary thiocyanate or expired air carbon monoxide. Both plasma and salivary thiocyanate also correlated significantly with depth of inhalation per cigarette but not with any other questionnaire index of smoking exposure. After six weeks of successful smoking cessation all three indices fell significantly. Plasma thiocyanate proved the most sensitive biochemical index for monitoring ultimate outcome, accurately dichotomizing 90% of subjects as successful or unsuccessful in their attempts to stop smoking. The use of all three variables allowed accurate classification of 96% of subjects. White cell count, red cell count and hemoglobin also correlated significantly with baseline cigarette consumption and a significant decrease in these hematological indices occurred consequent to successful smoking cessation. However, these hematological changes were not as sensitive as biochemical indices in monitoring successful outcome.
Adult↗
Dementia in elderly outpatients: a prospective study.
We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing features of reversible dementia were shorter duration, use of more prescription drugs, and less severe dementia. Almost half of the patients had other previously unrecognized treatable medical diseases. Most diagnoses were made from patient history and physical and mental status examination. Patients with reversible dementia improved but rarely reverted to normal. Objective improvement occurred in 25 patients after treating unrecognized coexistent medical and psychiatric diseases, or stopping unnecessary medication. Careful clinical observation is the most useful part of the evaluation and extensive testing may not be required for all patients. Overemphasis on distinguishing reversible from irreversible forms of dementia may detract from recognition of commoner, treatable causes of dysfunction and suffering.
Aged↗
Oestrogens and endometrial cancer: effect of other risk factors on the association.
We analyzed data from a case-control study of endometrial cancer to determine whether, in a woman's menstrual and medical history, factors could be identified that modify the increased risk resulting from menopausal oestrogen use. Overweight, hypertension, low parity, non-smoking, late age at menopause, and a history of cholecystectomy were all associated with endometrial cancer, but oestrogen use produced large increases in risk both in the presence and absence of these characteristics. We conclude that information on other known risk factors for endometrial cancer provides little or no guidance as to which patients to select in the perimenopause.
Adenocarcinoma↗