Biomedical subjects

J E Byles

Publications and source records attributed to J E Byles.

28 records · Page 2Linked to original sources

PubMed1997

A survey of screening compliance among first degree relatives of people with colon cancer in New South Wales.

OBJECTIVE: To survey screening practices, knowledge, and attitudes towards screening among first degree relatives of people with colon cancer. SETTING: A random sample of people with colon cancer listed on the New South Wales (NSW) Cancer Registry were mailed a questionnaire to be passed on to an appropriate first degree relative. METHODS: Two hundred and twenty five first degree relatives completed a self administered questionnaire. RESULTS: Although there were high levels of awareness about colorectal cancer, and attitudes towards colorectal cancer were generally positive, screening rates were low, and only three relatives had been screened in accordance with current Australian recommendations. Factors associated with previous participation in any type of screening test (usually once) included receiving a medical recommendation to screen, having more than one relative with colorectal cancer, being a sibling of the relative with colon cancer, the relative with cancer being female, and perceiving screening as messy, but not painful. CONCLUSIONS: Strategies to enhance screening awareness and participation among relatives need to be considered. This study provides some insight into factors to be considered in developing awareness programmes. Further research is required to explore these factors, and to identify ways to overcome barriers.

Adult↗

PubMed1996

Asthma presentations to emergency departments in western Sydney during the January 1994 Bushfires.

BACKGROUND: From 5 to 12 January 1994, the state of New South Wales suffered from the worst bushfires seen this century. High levels of particulate air pollution were recorded in western Sydney from 7 to 14 January 1994, with nephelometry readings reaching 10.24 beta scat (10(-4)/m) and particulate matter < 10 mu readings peaking at 250.00 micrograms/m3. The aim of this study was to determine whether there was an increase in the proportion of asthma presentations to emergency departments (ED) in western Sydney as a result of the bushfire-generated particulate air pollution. METHOD: We retrospectively analysed the emergency room attendance books for asthma presentations from seven public hospitals serving the Western Sydney and Wentworth Health Areas over two 6-7 week periods, 17 December 1992 to 31 January 1993, and 17 December 1993 to 31 January 1994. Air pollution and meteorological data were obtained from local monitoring stations. RESULTS: The difference in the proportion of all ED presentations that were due to asthma during the week of the bushfire-generated air pollution, compared with the same week 12 months before, after adjusting for baseline changes over the 12-month period, was 0.0067 (95% CI: -0.0007, 0.0141). The maximum daily nephelometry reading was not a significant predictor of the daily number of asthma presentations to ED in any of the Poisson regression models. CONCLUSIONS: The bushfire-generated particulate air pollution in January 1994 did not result in an increase in asthma presentations to ED in western Sydney.

Adolescent↗

PubMed1996

Mass mailing campaigns to promote screening for cervical cancer: do they work, and do they continue to work?

Campaigns involving sending personally addressed letters to encourage women to have Pap smears increase Pap smear rates. The aim of this study was to assess whether this effect is maintained when campaigns are repeated regularly. In October 1992, a letter reminding women of the importance of screening was mailed to all women in three New South Wales postcode regions where a similar letter had been sent three years previously. The response was compared to the response in three regions receiving no earlier letter. The number of women attending for cervical screening during the three months after distribution of the letters was assessed from Health Insurance Commission claims for cervical cytology. These attendances were compared with expected attendances based on the attendance patterns over 28 pre-intervention quarters. Significant postintervention increases in attendance were observed in all three regions receiving an initial letter. However, in one region, the increase in attendances, around 1 per cent of eligible women, was not significantly greater than the increase in the control region (z = 0.15, P = 0.88). The second letter campaign had no measurable effect on attendances. No significant increase in screenings was observed in two of the towns. A significant increase was observed in one region, but this was not significantly greater than the increase in the control region (z = -0.05, P = 0.96). These results suggest that repeated direct-mail campaigns to promote screening for cervical cancer may be of no benefit. A one-off campaign may result in an increase in screenings in the short term.

Adolescent↗

PubMed1996

A collaborative approach to cervical cancer screening.

OBJECTIVE: The main objective of this project was to evaluate a collaborative nurse and general practitioner approach to improve screening for cervical cancer. DESIGN: Multiple group time series design. SETTING: Six postal areas in the Hunter Valley of New South Wales, Australia, chosen as intervention sites because of very low Pap test rates compared with the rest of NSW (fewer than 50% of women screened). Six regions of similar size and with similar baseline screening levels were selected as comparison sites. SUBJECTS: All women selected in the resident postal areas. INTERVENTIONS: Women's health nurses worked in collaboration with general practitioners within the communities selected from within the Hunter area to promote and provide screening for cervical cancer. MAIN OUTCOME MEASURES: Qualitative information on initial expectations and impressions of the collaborative processes were collected at the start of the project period. Process data on client characteristics and Pap test results were obtained from minimum data collections; client satisfaction was assessed from client surveys. Outcome data on the increase in the number of women in each community who were screened for cervical cancer were obtained from Health Insurance Commission claims for screening Pap tests (and from nurses' records where Pap tests were examined under block funding arrangements). RESULTS: This project showed that nurses and general practitioners can collaborate to provide appropriate and highly acceptable cervical cancer screening services for women. Many of the women screened by the nurses were in the high risk age range for cervical cancer (40 years and older) and had only basic education levels, thus representing women who are most likely to have poor screening rates. Further, 33.1% of the women screened had not had a Pap test in the past four years or had never been screened. The number of women having a Pap test during the first six months of the project, compared with the number expected from preintervention patterns, was significantly greater in four intervention areas (P < 0.01). No corresponding increase was seen in comparison areas with similar screening rates at baseline. CONCLUSIONS: There is great potential for nurses to work in collaboration with general practitioners to improve the availability and coverage of community cervical cancer screening programmes.

Australia↗

PubMed1995

What are women told about Pap smears that lack endocervical cells?

BACKGROUND: Debate exists about the definition of what constitutes an adequate Pap smear and about the recommended rescreening interval for Pap smears lacking an endocervical component. This study aimed at determining whether women are currently informed about the endocervical status of their Pap smears and what rescreening recommendations are made to women whose smears lack endocervical cells. METHOD: Consecutive Pap smears lacking an endocervical component were identified from pathology records. After obtaining consent from the referring doctor, 165 women were interviewed by telephone. RESULTS: Only 110 (67%) of 165 women received active notification of their Pap test result and only six (4%) were aware that their smear lacked endocervical cells. Thirteen (8%) had been advised to have a repeat smear within three months. Nearly half the women reported that they would like more information about their result. CONCLUSIONS: It seems that current Pap smear notification patterns for women in New South Wales could be improved. One third are not actively informed at all about their results, and few are given detailed information about their Pap test results. Methods of enhancing the level of information women are given about their medical and screening tests need to be improved.

Adult↗

PubMed1994

Reliability of naevus counts in identifying individuals at high risk of malignant melanoma.

The majority of deaths from malignant melanoma could be prevented by regular screening of at-risk individuals. However, the feasibility of introducing active screening programmes depends on the reliability of criteria for identifying those individuals who are at increased risk. Several case-control studies indicate that one of the most important risk factors is the number of benign pigmented naevi. This criterion might constitute a practical means of identifying individuals suitable for inclusion in an active screening programme. The aim of this study was to assess the reliability of using naevus counts as an indicator of risk. Two possible methods of assessment were compared: assessment by trained interviewers, and assessment by experienced dermatologists. The results suggest that this criterion may not be as practical or reliable as originally anticipated. Interviewer naevus counts correlated poorly with dermatologists' assessments (kappa = 0.19). Counts by dermatologists of the number of naevi on the left arm differed by up to nine naevi, although most counts were within four naevi of each other. There was reasonable correlation between naevus counts on the left arm and those on the whole body (r = 0.71). However, the relationship was not perfect. Selection of individuals for screening solely based on the number of naevi on the left arm may exclude many people with high total body counts but relatively low left arm counts.

Arm↗

PubMed1994

Effectiveness of three community based strategies to promote screening for cervical cancer.

OBJECTIVE: Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media combined with general practitioner based (GP based) recruitment. SETTING: A trial of each intervention was carried out in three postal regions in New South Wales, Australia-a rural locality (containing about 1000 women), a country town (about 3000 women), and a major rural centre (about 10,000 women). Three control regions were selected to be demographically similar to the corresponding intervention regions. METHODS: Outcome data on regional Pap smear rates were obtained from government health insurance claims for cervical screening, and from pathology service records. Expected Pap smear rates for the three months after the intervention were predicted from 45 pre-intervention months and were compared with observed rates for this period. RESULTS: Television media alone was associated with a significant increase in attendances for screening in one of the three regions where a trial was carried out: 13.3% in the rural centre. The media/letter based campaign was associated with a significant increase in attendances in two out of three regions: 52.7% in the rural locality, 43.2% in the rural centre. The media/GP based campaign was associated with significant increases in attendances in all three regions: 50.2% in the rural locality, 80.8% in the country town, 15.7% in the rural centre. All three interventions were associated with significant increases in the number of women attending for cervical screening above those observed in the control regions. Furthermore, these increases were not restricted to women at low risk. They were also found for older women (aged 50-69 years) and women who had not had a Pap smear within the past three years.

Aged↗

PubMed1992

Delay in consulting a medical practitioner about rectal bleeding.

STUDY OBJECTIVE: The aims were to estimate the incidence of rectal bleeding in the community, and to determine the proportion of individuals who delay or fail to seek medical advice after a first episode of rectal bleeding. DESIGN: The data were collected as part of a large scale general population survey of the health practices and attitudes of individuals in a randomly selected sample of 2121 households. SETTING: The survey was conducted in the Newcastle and Lake Macquarie areas of New South Wales, Australia, during 1987-88. PARTICIPANTS: Information about rectal bleeding was collected from 1213 individuals aged 40 years and over. MEASUREMENTS AND MAIN RESULTS: Of the 1213 people aged 40 years and over, 239 (20%) reported noticing rectal bleeding at some time in their life. However, since an estimated 4.5% had noticed rectal bleeding for the first time in the past year the true lifetime incidence of rectal bleeding is likely to be much higher. Of the 77 individuals who had noticed a first occurrence of rectal bleeding more than three months but less than five years prior to the interview, 23 (30%) had either not sought medical advice or had only done so after a period of delay. The most commonly reported reason for delay or failure to consult was thinking that the bleeding was not serious and would clear up by itself. CONCLUSIONS: The data suggest that prompt investigation of rectal bleeding is not occurring in a relatively large proportion of cases. However, in the absence of firm evidence that early detection improves prognosis, and considering the costs of screening, it would be premature to initiate programmes which encourage people to seek care promptly for this symptom.

Adult↗

PubMed1992

Early detection of colorectal cancer: a profile of current practice.

This study examines the prevalence of colorectal cancer screening among individuals in the general community. The survey was undertaken as part of a large scale general population survey of health practices and attitudes. A sample of 1090 people aged 40 years and over with no previous history of colorectal cancer or other predisposing condition was interviewed. Only 56% of this group reported that they regularly checked their bowel movements, the toilet bowl, or the toilet paper for signs of rectal bleeding. Only 13% could recall a doctor ever advising them to check for rectal bleeding; and 21% could recall a doctor asking them if they had ever noticed blood in their bowel movements. More involved practitioner-based procedures, such as digital rectal examination, fecal occult blood testing, endoscopy, and barium enema, were reported by only a minority of participants. Analysis of screening rates in the 9.3% of people who reported a family history of colorectal cancer revealed that this higher risk group was no more likely to be screened than those at average risk.

Adult↗

PubMedDate not supplied

Effects of parenteral nutrition support and chemotherapy on the phasic composition of tumor cells in gastrointestinal cancer.

BACKGROUND: Some clinical studies report the effects of parenteral nutrition in malnourished cancer patients, but few discuss the tumor response to parenteral nutrition plus chemotherapy. If used in combination, the antitumor activity of chemotherapeutic agents may compensate for the tumor stimulation of parenteral nutrition. METHODS: Ninety-two patients with operable gastrointestinal cancer and malnutrition were randomly assigned to four interventions that were administered for 7 days preoperatively: parenteral nutrition alone, parenteral nutrition plus chemotherapy, chemotherapy alone, or no treatment (control). The preintervention and postintervention DNA content, DNA index, percentage of cells in S phase, and tumor cell sensitivity to chemotherapy were measured using image cytometry. RESULTS: Parenteral nutrition resulted in a significant proliferation of tumor cells and a significant increase in the sensitivity of tumor cells to chemotherapy; these effects were not seen in tumors of patients receiving parenteral nutrition plus chemotherapy. There was, however, a nonsignificant increase in tumor cell proliferation and sensitivity to chemotherapy in the tumors of subjects receiving combined therapy compared with those of subjects who received chemotherapy alone. The postintervention nutritional status of both the parenteral nutrition group and the parenteral nutrition plus chemotherapy group were significantly better than that of the control group and the chemotherapy group. The short-term, postoperative clinical outcomes in the chemotherapy group were significantly worse than those in the other three groups. CONCLUSIONS: These results indicate that combining chemotherapy and nutrition support preoperatively for malnourished patients with gastrointestinal cancer improves short-term nutritional status without increasing the proliferation of tumor cells and prevents the postoperative complications that occur when such patients are given chemotherapy without nutrition support. The results also suggest--but do not prove--that parenteral nutrition may increase the effectiveness of chemotherapy in malnourished patients.

Adult↗