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K Jamrozik

Publications and source records attributed to K Jamrozik.

At least 73 records · Page 4Linked to original sources
PubMed1997

The effect of spatial definition on the allocation of clients to screening clinics.

We compared four strategies for inviting 91,456 women aged 50-69 years to one of six clinics for mammography screening and 40,142 men aged 60-79 years to one of 10 clinics for abdominal aortic aneurysm (AAA) screening. The strategies were invitation to the clinic nearest to the client and invitation to the clinic nearest to the client's area of residence defined by census small area, postcode and local government area. For each strategy we calculated the expected demand at each clinic and the travel distances for clients. We found that when women were allocated to mammography clinics on the basis of the local government area instead of their individual address, expected demand at one clinic increased by 60%, and 19% of clients were invited to attend a more remote clinic, entailing 99,000 km of additional travel. Similar results were obtained for men allocated to AAA clinics by their postcode of residence instead of their individual address: 55% difference in expected demand, 13% to a more remote clinic and 60,000 km of extra travel. Allocation on the basis of small areas did not show such great differences, except for travel distance, which was about 5% higher for each clinic type. We recommend that allocation of clients to screening clinics be made according to residential address, that assessment of the location of clinics be based on distances between residences and nearest clinic, but that planning new locations for clinics be aided with spatial analysis tools using small area demographic and social data.

Aged↗
PubMed1997

Falling incidence of amputations for peripheral occlusive arterial disease in Western Australia between 1980 and 1992.

OBJECTIVES: To assess temporal trends in the incidence of surgical procedures for peripheral occlusive arterial disease (POAD) and associated changes in outcome as measured by the rate of major lower limb amputations for POAD. DESIGN: A retrospective descriptive population-based study was conducted of the geographically isolated population of Western Australia between 1980 and 1992. METHODS: Vascular procedures with an accompanying diagnosis of POAD were identified in a computerised system of name-identified records of all discharges from hospital for the population. These procedures were detected using relevant codes from the International Classification of Diseases and Procedures. Records of angioplasty and thrombolysis procedures were augmented by searches of hospital-based registers of invasive radiological procedures. The data for the remaining procedures were validated by a review of a random sample of medical records. RESULTS: Over the 13 years of the study, rates of major amputations fell significantly for women under 70 years of age and for men under 80 years from 1983. At the same time there was a significant fall in non-amputation vascular surgery for individuals under the age of 60. In addition, rather than an overall rise in surgery there was shift away from sympathectomy and thromboendarterectomy to angioplasty and bypass surgery. Furthermore, an increasing proportion of all major amputations had a prior attempt at arterial reconstruction. CONCLUSION: These observations suggest the decrease in major amputations for POAD may reflect a fall in the incidence of POAD, possibly aided by more effective surgery, rather than increased rates of vascular surgery.

Adult↗
PubMed1997

Breast cancer in Western Australia in 1989. V: Outcome at 5 years after diagnosis.

BACKGROUND: A follow-up study was undertaken of all Western Australian women who had a new diagnosis of breast cancer during 1989. The aims were to determine survival, frequency of recurrence and quality of life (QoL) of Western Australian women 5 years after a diagnosis of breast cancer; to determine reasons for choice or rejection of reconstructive surgery in those women treated by mastectomy, and to determine if the choice of lumpectomy or mastectomy affects subsequent QoL. METHODS: The vital status as at 1st June 1994 of all 692 women who had a new diagnosis of breast cancer in 1989 was ascertained by electronic linkage to official mortality registrations. A subsample of 215 survivors who had originally been treated by the nine surgeons who had managed 20 or more cases each was sent a reply-paid postal questionnaire asking about follow-up treatment since diagnosis, recurrence of disease, current QoL and attitudes to, and use of, reconstructive surgery. RESULTS: The overall survival rate at 5 years was 80.8% (85.9% and 78.8% for Stage I and II, respectively). Cumulative mortality was 35% lower among the third of patients treated by the nine most active surgeons (14% vs 22%, P < 0.02), but this may be subject to referral bias. The subsample was representative of all surviving cases except for being an average of 2.7 years younger at diagnosis (mean ages 55.2 and 57.9 years). The response rate of the subsample to the postal questionnaire was 78%. Of women who had had a mastectomy, 40% had considered having a reconstruction, but only nine (11%) had undergone this operation. Median QoL on the Rosser scale (maximum = 1.0) was 0.9. QoL was worse for the 23% of patients with a recurrence of breast cancer. Patients treated by breast-conserving surgery showed a trend toward a better QoL compared with those treated by mastectomy. CONCLUSION: At 5 years after the diagnosis of breast cancer, one in five women had died and an estimated one in four of the survivors had recurrent disease. Quality of life in the remaining patients, half of whom had undergone adjuvant treatment, was very good. These are important baseline data against which to judge the impact of mammographic screening.

Australia↗
PubMed1997

Risk factors for sudden unexpected cardiac death in Tasmanian men.

BACKGROUND: Sudden unexpected cardiac death (SUCD) accounts for approximately 25% of deaths from ischaemic heart disease (IHD) but is relatively poorly understood because of the difficulties involved in researching aetiology. Clinical differences between instances of SUCD and those cases of acute chest pain that survive long enough to be proven as myocardial infarction but are eventually fatal might reflect differences in aetiology. AIMS: To determine the risk factors for sudden unexpected cardiac death in Tasmanian men. METHODS: A population-based case-control method was used with the study population, an estimated 125,225 men aged 25-74 years living in the island State of Tasmania, Australia. The case group of 102 men who had a SUCD was validated using necropsy reports, hospital records and information provided by the usual general practitioner. Cases were matched with 204 community controls. Spouses or partners of eligible subjects answered a detailed questionnaire. Multi-variate odds ratios (ORs) for risk factors were calculated using stepwise analysis. RESULTS: Risk factors measured included: smoking habit, treated hypertension, hypercholesterolaemia, diabetes mellitus, family history of IHD, alcohol intake and exercise habits. Independent risk factors for SUCD were: history of diabetes mellitus (OR = 4.2, 95% CI: 1.39, 12.81), current smoking status (OR = 3.5, 95% CI: 1.80, 6.82), and family history of IHD (OR = 2.6, 95% CI: 1.34, 4.92). CONCLUSIONS: Some accepted risk factors for acute myocardial infarction (AMI) also predict sudden death in men with no history of coronary disease. Efforts to reduce smoking, the incidence of diabetes mellitus and mean blood pressure must be continued as SUCD is, by definition, untreatable but is potentially avoidable in many instances.

Adult↗
PubMed1997

Stroke. A looming epidemic?

A recent deceleration in the long established downwards trend in mortality from stroke combined with rapid ageing of the Australian population suggests that we may be facing a large and rapid increase in the caseload of stroke unless efficacious ways to prevent cerebrovascular disease are applied more systematically. This paper reviews the current situation, drawing on evidence from the Perth Community Stroke Study (PCSS).

Aged↗
PubMed1996

Clinical epidemiology: an experiment in student-directed learning in Western Australia.

This paper describes an experiment at the University of Western Australia (UWA) medical curriculum, in which the focus of the 1 week of face-to-face teaching in public health in the 3-year clinical rotation was changed from important health problems affecting whole communities to one emphasizing the use of epidemiological principles to enhance doctors' decision-making. The students are now left to choose the clinical subject matter, and instead of being presented with predetermined readings selected by the teaching staff, the students have assumed responsibility for discovering the latest relevant information on the topics they choose and of presenting this to the class. The teacher now spends much less time in front of the class, providing only mini-tutorials each day on presenting to small groups, and on the skills required to understand the published literature on the aspects of the diagnosis, investigation, management and prognosis of individual patients. The topics chosen by students for exploration differ little, either in terms of the nature of the health problems concerned or the epidemiological principles at issue, from those covered previously when the programme was set entirely by the staff. However, attendance at the course has improved sharply, the short time between mini-tutorials and application of the material they cover has increased the perceived relevance of the teaching, and feedback collected systematically from successive classes of students has been very positive. Any anxiety on the part of the staff at relinquishing control of the curriculum has proved unfounded while the new programme has much to recommend it as a model of self-directed learning.

Community Medicine↗
PubMed1996

A case-control study of childhood pedestrian injuries in Perth, Western Australia.

STUDY OBJECTIVES: To identify the determinants of childhood pedestrian injuries, taking the child's exposure to the road environment into account. DESIGN: This was a case-control study. SETTING AND PARTICIPANTS: The study was conducted in Perth, Western Australia between 1991 and 1993. Altogether 100 injured and 400 uninjured child pedestrians aged 1 to 14 years were studied. Aspects of the child's social and physical environments, measures of his or her behaviour, cognitive skills, and "habitual" exposure to the road environment, as well as his or her knowledge of road safety, were recorded. MAIN RESULTS: The likelihood of injury increased by 12% with each 10,000 vehicles per day increase in the volume of traffic (odds ratio (OR) 1.12, 95% confidence interval (CI) = 1.05, 1.19) on roads most frequently crossed. In addition, the presence of visual obstacles on the verge of the child's street of residence increased the likelihood of injury by more than 2.6 times (OR 2.68, 95% CI = 1.42, 5.02). In contrast, the absence of footpaths was associated with a 52% reduction in the likelihood of injury compared with the presence of footpaths on the child's street of residence (OR 0.48, 95% CI = 0.27, 0.87). CONCLUSION: The amount of exposure to the road environment and the nature of the road environment to which the child pedestrian was exposed partly influenced the likelihood of injury in children from low socioeconomic areas, male children, and children aged 13 to 14 years. Until now, the excess incidence of childhood pedestrian injuries in these subgroups of the population had not been explained because the child's exposure per se had not been examined.

Accidents, Traffic↗
PubMed1996

[Myocardial infarction--risks and procedures. Longitudinal observation of a population of 280,000 women and men--Project POL-MONI CA Krakow. III: Epidemiology and treatment of myocardial infarction].

There has been a large amount of progress in the methods of prevention and treatment of ischaemic heart disease (IHD), but the effect of these changes on mortality due to IHD has not been assessed. This paper presents the complex analysis of 10-year trends of incidence, case fatality and mortality due to myocardial infarction (MI) and changes in medical care in the acute phase of MI in residents of one province of Poland-Tarnobrzeg Voivodship, which was the target population of the POL-MONICA Kraków Project (over 280,000 men and women at age 25-64 years). In men, the incidence of MI, which was 335/100,000 in 1984, increased in 1986 to 463/1,000,000 and then was stable until 1993 when it felt to 362/100,000. Mortality from MI, which was 149/100,000 in 1984, increased to 212/100,000 in 1986 and then was stable until 1992, before falling to 173/100,000 in 1993. There were large fluctuations in the incidence and mortality from MI in women i.e. from 58/100,000 to 116/100,000 and from 21/100,000 to 55/100,000 respectively. In 1993 the incidence was 82/100,000 and mortality was 32/100,000. After adding sudden deaths and other fatal events attributed to IHD the mortality figures increased over the ten years of observation by an average of 29% in men and by 28% in women. The average total MI case fatality was 47% in men and 40% in women, with 86% of all deaths due to MI occurring out of hospital. Case-fatality of MI managed in hospital was 11% on average.

Adrenergic beta-Antagonists↗
PubMed1995

Breast cancer in Western Australia in 1989: IV. Summary of histopathological assessment in 655 cases.

This study was part of a population-based survey of all cases of breast cancer diagnosed in Western Australia in 1989. The paper concerns histopathology reporting by pathologists in 655 cases of carcinoma of the breast in that year, before the introduction of mammographic screening programmes. Pathological features of the neoplasms are documented, and the extent to which information known to be of clinical or prognostic importance was included in the reports is analysed. 96.5% of all pathology reports included information on breast cancer subtype and, in 98.6% of cases with axillary dissection, the number of lymph nodes dissected, and the number containing metastatic tumor was stated. In 83.7% of cases of invasive carcinoma exact tumor dimensions were recorded. In 44.9% of cases histological grade was recorded, and information about excision margins was present in 60% of reports overall. The reporting of pathological features in many instances was limited by the way in which the specimen was handled prior to reception. At the time of the study, views about the importance of many aspects of histological assessment were still evolving. Even now, for example, consensus is still being reached on the value of histological grading in predicting prognosis and whether reliable histological assessment of such factors as extent of DCIS and completeness of excision of DCIS is possible. The introduction of mammographic screening since 1989 has provided a focus for wider discussion about the value of histological information in prognostication and patient management. A case is made to support the use of "check lists" for surgical pathology reports in cases of breast cancer.

Adolescent↗
PubMed1995

Screening instruments for depression and anxiety following stroke: experience in the Perth community stroke study.

Evaluation of the relative efficacy of three screening instruments for depression and anxiety in a group of stroke patients was undertaken as part of the Perth community stroke study. Data are presented on the sensitivity and specificity of the Hospital Anxiety and Depression Scale (HAPS), the Geriatric Depression Scale and the General Health Questionnaire (GHQ) (28-item version) in screening patients 4 months after stroke for depressive and anxiety disorders diagnosed according to DSM-III criteria. The GHQ-28 and GDS but not the HADS depression, were shown to be satisfactory screening instruments for depression, with the GHQ-28 having an overall superiority. The performance of all 3 scales for screening post-stroke anxiety disorders was less satisfactory. The HADS anxiety had the best level of sensitivity, but the specificity and positive predictive values were low and the misclassification rate high.

Adult↗
PubMed1995

Age and secular trends in risk factors for cardiovascular disease in Busselton.

Mortality rates from heart disease and stroke in Australia have been falling for more than 20 years. No completely satisfactory explanations for this trend exist. However, it is believed to be due, at least in part, to changes in the incidence of cardiovascular disease arising from changes in the prevalence and severity of risk factors for cardiovascular disease. The adult community of Busselton in Western Australia participated in cross-sectional health surveys every three years from 1966 to 1981. This paper describes secular trends from 1966 to 1981 and age trends from 25 to 80 years for cardiovascular risk factors in Busselton men and women. Downwards secular trends were observed for mean blood pressure and smoking for men and women, upwards trends were observed for body mass index in men, and mean cholesterol was approximately constant over this period. The age and secular trends were consistent with other Australian studies conducted in the 1980s and with overseas studies. An estimated 67 per cent of the decline in cardiovascular mortality rates among Busselton men and 22 per cent of the decline among Busselton women may be attributed to changes in the prevalence of risk factors for cardiovascular disease.

Adult↗
PubMed1995

Beliefs and behaviour of general practitioners regarding promotion of physical activity.

To assess current practice, perceived desirable practice and barriers related to the promotion of physical activity in general practice, a questionnaire was developed and distributed to all 1228 general practitioners in Perth. From these, 789 valid returns were received (71 per cent response). The mean age of the respondents was 45 years, 69 per cent were male, 52 per cent had postgraduate qualifications and 73 per cent were in full-time practice. General practitioners most frequently asked patients about their current level of physical activity and discussed physical activity programs when seeing patients with symptoms of conditions that could benefit from exercise, rather than asking all patients, new patients or patients previously seen. Walking specifically for fitness was the activity most likely to be recommended. General practitioners felt more able to offer general advice than specific advice on physical activity. Lack of time was reported most frequently as a barrier to the promotion of physical activity (47 per cent), followed by insufficient educational materials (29 per cent), and preference of patients for drug treatment (27 per cent). There were significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by general practitioners. Future strategies should aim to increase the frequency of advice to patients with specific health conditions.

Attitude of Health Personnel↗