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Biomedical subjects

K Jamrozik

Publications and source records attributed to K Jamrozik.

At least 91 records · Page 5Linked to original sources
PubMed1994

Breast cancer in Western Australia in 1989: III. Accuracy of FNA cytology in diagnosis.

A population-based study of all cases of breast cancer diagnosed in Western Australia (WA) in 1989 revealed 701 cases of cancer in 692 women. Three hundred and ninety-six (56.5%) of these cancers had fine needle aspiration (FNA) cytology. Forty-three cases were managed non-surgically, on the basis of an FNA diagnosis and without histologic follow up. Of the cases with histological follow-up, 73% received an unequivocal diagnosis of malignancy by FNA, and abnormal cells (atypical, suspicious or malignant diagnoses) were reported in 94.2%. Of the cases, 3.2% were reported as benign and in 2.6% the samples taken were unsatisfactory. There were no false positive cytological diagnoses of malignancy. This study is the first to examine the results of FNA diagnosis of breast cancer from a medical community as a whole, rather than for individual or specialist units; the accuracy of diagnosis was similar for different pathology practices including public and private sector laboratories. Lower absolute sensitivity (the proportion of cases given an unequivocal diagnosis of malignancy) was seen in very small and very large tumours, pure duct carcinoma in situ (DCIS), and invasive lobular carcinoma. False negative rates (the proportion of cases given a benign cytological diagnosis) were very low for all laboratories (0-4.5%) and for all types of carcinoma, and the proportion of unsatisfactory samples was exceptionally low for all laboratories (0-4.5%). The overall figures for accuracy are similar to those reported from other centres in Australasia and overseas, and confirm the effective use of FNA cytology throughout the clinical and pathology community in WA.

Adenocarcinoma, Mucinous↗
PubMed1994

The role of lifestyle factors in the etiology of stroke. A population-based case-control study in Perth, Western Australia.

BACKGROUND AND PURPOSE: We sought to examine risk factors for all strokes and for ischemic stroke and primary intracerebral hemorrhage separately. METHODS: This was a population-based case-control study. Each case subject meeting World Health Organization criteria for stroke (n = 536) from a population-based register of acute cerebrovascular events compiled in Perth, Western Australia, in 1989 to 1990 was matched for age and sex with up to five control subjects drawn from the same geographical area. Objective confirmation of the type of stroke was available from computed tomography, magnetic resonance imaging, or necropsy for 86% of the case subjects. Data on medical history and lifestyle factors were collected from case and control subjects by interview of the subject or a proxy informant. RESULTS: Current smoking, consumption of meat more than four times weekly, and a history of hypertension or intermittent claudication were each associated with increased risk in multivariate models for all strokes and for all first-ever strokes. Consumption of 1 to 20 g/d alcohol in the preceding week was associated with a significant reduction in the risk of all strokes, all ischemic strokes, and of primary intracerebral hemorrhage, while eating fish more than two times per month appeared to protect against first-ever stroke and against primary intracerebral hemorrhage. Diabetes mellitus was associated with a significantly increased risk of ischemic stroke but a decreased risk of hemorrhagic stroke. CONCLUSIONS: Risk factors for ischemic and hemorrhagic stroke are not exactly the same. Changes in lifestyle relating to tobacco and diet might make important contributions to further reductions in the incidence of stroke.

Alcohol Drinking↗
PubMed1993

Sudden unexpected cardiac death among Tasmanian men.

OBJECTIVE: To examine sudden unexpected cardiac death (SUCD) in Tasmanian men and to assess the contribution of these deaths to differences in rates of mortality from ischaemic heart disease (IHD) between regions within Tasmania. DESIGN AND SETTING: Descriptive epidemiological study based in the community. SUBJECTS: Male residents of Tasmania aged 30 to 69 years who died from IHD suddenly and unexpectedly between 1987 and 1989. MAIN OUTCOME MEASURES: Rates and proportions of sudden cardiac death in men who had no prior overt signs of IHD, validated by necropsy and information from the attending doctors. RESULTS: SUCD accounted for approximately 24% of deaths from IHD among men aged 30 to 69 years in Tasmania. The ratios of observed to expected numbers of deaths occurring among manual and nonmanual workers were similar whereas there was an excess of events among men aged less than 65 years who were not working. Examination of data from necropsy reports revealed that 32% of cases showed evidence of previous "silent" myocardial infarction and 63% showed severe coronary artery disease in two or more vessels, with a further 28% having severe single vessel disease. The contribution of SUCD to total mortality from IHD varied from 20% in the north-west region to 25% in the south and 26% in the north, but the limited number of events makes it uncertain whether the variation in the rate of SUCD is significantly different from that for total mortality from IHD. CONCLUSIONS: The proportion of deaths from IHD among men in Tasmania which are sudden and unexpected and the associated necropsy findings are consistent with those described in other population based studies of sudden cardiac death. Non-participation in the workforce was a risk factor in SUCD. As yet, we cannot distinguish whether the higher mortality rates from IHD among men in northern regions of Tasmania (P < 0.01) were due to differences in SUCD or whether the same rate of SUCD obtains in all regions of the State and the differences in mortality from IHD reflect variation in non-sudden deaths and deaths in people with overt IHD.

Adult↗
PubMed1993

Breast cancer in Western Australia in 1989. I. Presentation.

This study was designed as a population-based study of all cases of breast cancer diagnosed in Western Australia (WA) in 1989. Cases were identified from the State Cancer Registry and from computerized hospital inpatient records. Data were obtained from the records of surgeons and oncologists managing the patients, hospital medical records, and pathology and cytology reports. A total of 701 histologically proven tumours were documented in 692 women. Of these 6.8% were not known to the State Cancer Registry. Two-thirds (68%) of tumours were first detected by the woman herself, 11% were found by a doctor and 11% were detected by mammographic screening. Stage I tumours accounted for 40% of tumours and Stage II 39%. The estimated lifetime risk of a WA woman developing at least one malignant breast tumour is 10%. Passive surveillance based upon a legal obligation on doctors to notify cases of cancer may be resulting in a significant under-estimation of the incidence of cancer in WA. Mammographic screening played only a small role in the detection of breast cancer in WA in 1989, but its contribution and the proportion of stage I tumours should both increase as a population-based mammographic screening programme is established. This survey will provide a yardstick against which changes can be measured. Eighty-four per cent of tumours presently occur in women who would have access to mammographic screening although only 44% occur in the 50-69 age bracket that is to be actively recruited. The lifetime risk of breast cancer in WA women is greater than has been appreciated previously.

Adult↗
PubMed1993

Breast cancer in Western Australia in 1989. II. Diagnosis and primary management.

This study was designed as a population-based study of all cases of breast cancer diagnosed in Western Australia (WA) in 1989. Cases were identified from the State Cancer Registry and from computerized hospital inpatient records. Data were obtained from the records of surgeons and oncologists managing the patients, hospital medical records and pathology and cytology reports. A total of 701 tumours in 692 women were treated by 105 different surgeons of whom 25 saw 10 or more cases. Over 70% were proven by cytology or biopsy within 2 weeks of presentation to a doctor. The first diagnostic investigation was fine needle aspiration in 45%, open biopsy in 28% and diagnostic mammogram in 24.4%. A definitive procedure involving breast conservation was performed in 31.3% of patients with operable tumours; 35.6% of those under 50 years of age. If axillary dissection or sampling was part of such treatment, 93.5% of those under 50 years and 75% of those 50 years and over had radiotherapy to the residual breast. Although less than one-third of patients were referred to a medical oncologist almost a half had adjuvant systemic therapy (92% of node positive and 23% of node negative patients). Tamoxifen was prescribed as part of adjuvant therapy in 93% of those over 50 years and cyclophosphamide, methotrexate and 5-fluorouracil in 71% of those under 50 years. Less than 10% of patients treated with mastectomy and axillary dissection had postoperative radiotherapy to the chest wall and drainage areas. The patterns of care of patients with breast cancer in WA prior to the introduction of population-based mammographic screening have been established.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Tobacco in Western Australia: patterns of smoking among adults from 1974 to 1991.

Patterns of smoking in Western Australia since 1974 were examined using four data sets. Consistency between sets of data was high for adults in the various categories of smoker status. Having established consistency, the patterns revealed by the surveys conducted by the Health Department of Western Australia were examined in more detail. According to these data, prevalence fell from 31.2 per cent in 1984 to 23.9 per cent in 1991 but was still higher among males, at 27.3 per cent, than among females, at 23.4 per cent. Although the sex-specific prevalence levels were converging, the difference was still significant (P = 0.01). While patterns of smoking in Western Australia generally reflected those in Australia as a whole, some differences were detected. The variation in prevalence according to level of education among women became less pronounced: in 1991, prevalence was 25.5 per cent among women who had completed an apprenticeship or trade certificate compared with 21.7 per cent among women who had undertaken some university studies, the corresponding figures for 1984 being 31.1 per cent and 24.8 per cent. Differences in prevalence among young women between state and national data were also noted. Between 1987 and 1991 the prevalence of smoking among women in the 20- to 24-year age group decreased from 41.2 per cent to 29.0 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Regional variation in coronary mortality within Tasmania.

OBJECTIVE: To measure regional rates of mortality from ischaemic heart disease (IHD) within Tasmania and to analyse factors associated with regional differences. DESIGN: Descriptive epidemiological study. SETTING: Community-based study. SUBJECTS: Male residents of Tasmania aged 30-69 years dying from IHD between 1986 and 1989. MAIN OUTCOME MEASURES: Coronary death as coded by the Australian Bureau of Statistics and place of death validated by hospital and community data. RESULTS: This study identifies substantial differences in coronary death rates among the three Health Regions of Tasmania. These differences are real and are not caused by variations in diagnostic or coding practices between regions. The two northern Health Regions, which represent approximately 52% of the total population, account for 98% of the excess mortality from IHD in Tasmania compared with the national rate. More detailed analysis of these differences suggests that variation in the number of deaths occurring in hospital contributes significantly to the regional differences in death rate from IHD. CONCLUSION: Rates of coronary mortality in Tasmania have been significantly higher than in all other Australian States for much of the past decade because of a higher death rate within the population of the northern half of Tasmania. Differences in mortality rates between regions in Tasmania provide a focus for further study into the causes of the unacceptably high rates of death from IHD in Tasmania and underline the need for the funding of a coronary register in Tasmania.

Adult↗
PubMed1992

Follow-up care after acute myocardial infarction.

OBJECTIVE: To examine the medical care received by patients following discharge from hospital after acute myocardial infarction (AMI). SETTING AND DESIGN: Community-based cross-sectional survey. PATIENTS: 2836 consecutive patients aged 25-64 years living in the Perth Statistical Division who were admitted to hospital with AMI during 1984-1988. After one reminder the response rate was 71%. RESULTS: Half of all respondents were in full-time employment at the time of their AMI. At follow-up this had fallen to a third. Over 80% of patients visited a cardiologist after AMI, with half remaining under consultant care to the time of survey. However, one in five patients reported no follow-up care at the time of survey. Seventy-three per cent of patients reported undergoing at least one exercise stress test after AMI, with 61% undergoing angiography, 16% angioplasty and 24% coronary bypass surgery. Large proportions of the patients accurately reported being prescribed beta-blockers and antiplatelet agents. The pattern of prescribing at discharge corresponded closely with the use of cardioactive agents at the time of survey and with drugs reported to have been taken continuously since discharge to the time of survey. CONCLUSIONS: These data suggest that follow-up care after AMI is both comprehensive and widespread. Such care may have contributed significantly to the overall decline in mortality from ischaemic heart disease.

Adrenergic beta-Antagonists↗
PubMed1992

Changing patterns of medical treatment in acute myocardial infarction. Observations from the Perth MONICA Project 1984-1990.

TYPE OF STUDY: Descriptive study of trends in the drug therapy for acute myocardial infarction. SETTING: Population-based register of acute coronary events compiled for the years 1984 to 1990 in the course of the Perth MONICA project. CASES: 5294 cases meeting clinical criteria for acute myocardial infarction. RESULTS: Striking changes were seen in the use of aspirin before admission to hospital (from 4% to 18%). During the stay in hospital the use of beta-blockers increased steadily from 52% to 76%, while the use of aspirin increased 3.5-fold from 25% to 88% and the use of streptokinase increased 13.5-fold from 2.4% to 32.4%. The proportion of patients prescribed beta-blockers on discharge from hospital increased from 46% to 65% and that for aspirin rose from 16% to 83%. There were also major relative increases in the use of lipid-lowering agents and declines in the use of antiarrhythmic drugs. CONCLUSION: These trends in the pharmacological management of myocardial infarction mirror the emerging evidence from clinical trials, although the increases in the use of certain types of drugs antedated publication of the results of major randomised studies. The changes in therapy would partly explain observed improvements in case fatality and may have contributed to the decline in coronary mortality observed in the Perth community.

Adrenergic beta-Antagonists↗
PubMed1992

Death certification and coding for ischaemic heart disease in Tasmania.

Official records show that the rates of mortality from ischaemic heart disease (IHD) in Tasmania have been the highest of all the Australian states for most of the past decade. This study assesses the accuracy of the official Tasmanian mortality data for IHD in 1987 and 1988 for males aged 25 to 74 years using routinely available clinical and pathological data supplemented by information from the attending doctor. Our findings show that a death officially coded to ICD 9 rubrics 410-414 (IHD) in Tasmania has 94% sensitivity and a positive predictive value of 90% for fatal definite acute myocardial infarction or possible coronary death as defined by the WHO. Comparison of our results with those of two earlier studies undertaken in Australian mainland centres indicates that differences in the official statistics for coronary mortality between Tasmania and the mainland states reflect true differences in the risk of coronary death. While the results from three Australian studies suggest that the routine system of death certification is reasonably accurate, careful monitoring of death certification and coding practices need to be undertaken regularly in all states of Australia if secular changes in regional patterns of coronary mortality are to be regarded as credible.

Adult↗
PubMed1992

Review of the benefits of treating hypertension.

The main points covered in this review are as follows: 1. Hypertension is a major determinant of cardiovascular disease (CVD). As such it is a major cause of mortality, potential years of life lost, morbidity and long-term disability. 2. The incidence of CVD is directly related to BP. It is likely that this extends over the full range of BP although some writers believe that a J-curve of risk exists for CHD. 3. The relationship between long-term disability from CVD and BP requires further study. 4. Because of regression dilution bias, the gradient in risk of stroke and CHD with BP has been underestimated in the past. Recent research suggests that the risk of stroke increases at least tenfold and CHD sixfold over a range of usual DBP of 30 mmHg (equivalent to approximately 50 mmHg baseline DBP). 5. The population attributable risk (PAR) of CVD related to general elevation of BP in the population from a mean daily excess of sodium intake of 100 mmol/day is at least 30%. In typical industrialised countries the PAR for stroke and CHD from clinical hypertension is 36% and 22%, respectively. These estimates of PAR provide a guide to the maximum benefit that could result from either restriction of sodium intake in the whole population or ideal management of all persons with hypertension. In practice such targets are unlikely to be realised. 6. Recent analyses of clinical trials of treatment of hypertension suggest that the risk of stroke is reduced at all levels of initial BP to the extent predicted from observational studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1991

Could we do more to prevent stroke?

Stroke remains an important cause of death and of permanent disability in our community. Although hypertension is still a major risk factor, data from the Perth Community Stroke Study are presented to show how smoking, consumption of alcohol, diabetes and certain dietary practices affect an individual patient's risk of stroke and the extent to which these factors might contribute to the overall burden of cerebrovascular disease borne by the community.

Australia↗
PubMed1990

Interstate differences in trends in coronary mortality and risk factors in Australia.

Mortality from coronary heart disease has declined by approximately 50% in Australia over the past 20 years and now accounts for approximately 25% of all deaths. Most of the decline in mortality from all causes in each State of Australia over the period 1972-1988 is due to the decline in mortality from coronary heart disease. In Tasmania, the rate of decline in mortality from all causes is significantly less in both sexes (P less than 0.01) than in the mainland States, and the discrepancy is due to a lesser decline in mortality from coronary heart disease (P less than 0.01). Trends in deaths related to hypertension show no differences between Tasmania and the other States, which suggests that the discrepancy with coronary heart disease is due to factors other than the prevalence and/or treatment of hypertension. Analysis of trends data on cigarette smoking prevalence, and cross-sectional data on plasma cholesterol levels and diet, shows that Tasmanian differences in food intake (including fat and cholesterol), in plasma cholesterol levels and (to a lesser extent) in cigarette smoking are consistent with, but are unlikely to explain completely, the slower rate of decline in mortality from coronary heart disease.

Australia↗
PubMed1990

Cardiovascular Diseases and Alimentary Comparison Study: preliminary analysis of data from Western Australia.

Data from 49 men and 48 women included in the Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study in Perth, Western Australia, were analyzed. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively correlated (p less than 0.01) with urine sodium, creatine, taurine, histidine, and 3-methyl histidine but not with calcium, magnesium, or potassium. SBP was related (p less than 0.01) with body mass index (BMI). Urine nitrogen, creatinine, and amino acids correlated (p less than 0.001) with each other and with urine sodium, potassium, calcium, and magnesium. Urine magnesium correlated (p less than 0.001) with urine calcium and potassium; urine calcium was not related significantly to urine sodium or potassium. In backwards multiple regression with data from urine collections, SBP was significantly related only to urine sodium (11.9% of variance explained). If alcohol was included as an independent variable, reducing the number of valid cases because of missing values, both alcohol and urine sodium were significant in regression (19.9% of variance explained). In men, DBP was significantly related to BMI and the ratio of 3-methylhistidine to creatine (23.7% of variance explained). For DBP in women, urine sodium was the only variable needed in regression (58.4% of variance explained). Interpretation must be cautious, because these analyses are based on relatively few cases and on single 24-h urine samples. The data are in keeping with suggestions that obesity, alcohol consumption, a meat diet, and sodium intake are important factors predisposing to elevation of blood pressure.

Blood Pressure↗