Biomedical subjects

V Siskind

Publications and source records attributed to V Siskind.

At least 37 records · Page 2Linked to original sources

PubMed1996

The menopause and hormone replacement therapy: Australian general practitioners' self-reported opinions, attitudes and behaviour.

OBJECTIVES: We describe the attitude and views of general practitioners towards the menopause and hormone replacement therapy (HRT) in metropolitan Brisbane, Australia. METHODS: A total of 216 general practitioners were nominated by a random sample of urband-welling women aged 45-54 years who formed the Brisbane Women's health study. A 20-30 minute face-to-face questionnaire with the general practitioners was administered and analysed by demographic characteristics. RESULTS: There was a 93% response rate. Management of the menopause and HRT was routinely undertaken by general practitioners for their own patients. After deciding to initiate HRT, > 60% of general practitioners ordered five investigations or more. They may have confused the risk of thrombo-embolism from oestrogens used in the post-menopause with that for contraception. There were differences between male and female practitioners in some areas. Male general practitioners, in particular, reported more difficulty with tailoring and adjusting regimes. CONCLUSIONS: Specific areas for further education are explored to meet the educational needs of general practitioners.

Adult↗

PubMed1996

Risk of colorectal adenomas in patients with a family history of colorectal cancer: some implications for screening programmes.

BACKGROUND AND AIMS: Most colorectal cancers (CRC) arise in colorectal adenomas. A case-control study was conducted to see whether a family history of CRC is associated with a higher prevalence of colorectal adenomas. SUBJECTS: Subjects were drawn from all patients who underwent colonoscopy at the Royal Brisbane Hospital between 1980-1982 and 1985, and included 141 cases with colorectal adenomas diagnosed at colonoscopy and 882 controls who were free of polyps at colonoscopy. METHODS: The prevalence of family history of CRC was compared between patients with adenomas and negative colonoscopy controls. RESULTS: Overall, patients with one first degree relative with CRC were at no greater risk for adenomas at colonoscopy than patients with no family history (odds ratio (OR) = 0.8, 95% confidence intervals (CI) = 0.4, 1.5). Patients with two or more affected first degree relatives had a more than doubled risk for adenomas (OR = 2.3, 95% CI = 0.5, 8.2), and were also more likely to carry moderately or severely dysplastic adenomas (OR = 14.1, 95% CI = 2.0, 62.9). CONCLUSIONS: These findings are consistent with the hypothesis that some families, in addition to those with familial adenomatous polyposis, have an increased susceptibility to develop colorectal adenomas, and that adenomas in such families may have a greater tendency to undergo malignant transformation.

Adenoma↗

PubMed1996

A three year outcome evaluation of a theory based drink driving education program.

This study reports on the impact of a "drink driving education program" taught to grade ten high school students. The program which involves twelve lessons uses strategies based on the Ajzen and Madden theory of planned behavior. Students were trained to use alternatives to drink driving and passenger behaviors. One thousand seven hundred and seventy-four students who had been taught the program in randomly assigned control and intervention schools were followed up three years later. There had been a major reduction in drink driving behaviors in both intervention and control students. In addition to this cohort change there was a trend toward reduced drink driving in the intervention group and a significant reduction in passenger behavior in this group. Readiness to use alternatives suggested that the major impact of the program was on students who were experimenting with the behavior at the time the program was taught. The program seems to have optimized concurrent social attitude and behavior change.

Adolescent↗

PubMed1996

Validating the process of taking lateral foot x-rays.

This study validates the concept that a standard (static) weightbearing lateral x-ray, taken with an orthoposer device, in the patient's angle and base of gait is clinically similar to findings seen during ambulatory (dynamic) gait. Sixty female subjects requiring diagnostic x-rays underwent videofluoroscopy of their walking gait. Using a single-frame, shuttle-advance video recorder, the appropriate fluoroscopic video frame was identified. The calcaneal pitch angle was measured using a digitized program. A high repeatability of the measuring process and high correlation between x-ray and fluoroscopic results suggest the value of taking weightbearing angle and base of gait lateral x-rays.

Adolescent↗

PubMed1996

Changes in the calcaneal pitch during stance phase of gait. A fluoroscopic analysis.

Calcaneal pitch has been considered to be an indirect measure of subtalar joint function. The aim of this pilot study was to assess changes in the calcaneal pitch angle during dynamic gait. Sixty female subjects underwent videofluoroscopy to obtain 27 usable gait cycle data. A single-frame, shuttle-advance video recorder was used to identify midstance of the gait cycle. The calcaneal pitch angle was measured during three midstance periods. The study confirms findings from video and forceplate analysis and reintroduces videofluoroscopy as a gait research tool.

Biomechanical Phenomena↗

PubMed1995

Reproductive and other factors and risk of epithelial ovarian cancer: an Australian case-control study. Survey of Women's Health Study Group.

Of the few factors known to be associated with epithelial ovarian cancer, the most consistently observed relate to women's reproductive function, although even here uncertainties remain. We have undertaken a case-control study involving personal interviews with over 1,600 women, the largest of its kind to date, to investigate further the associations between women's reproductive histories and other factors and the development of ovarian cancer. Cases were drawn from women diagnosed with epithelial ovarian cancer in 3 Australian states, Queensland, New South Wales and Victoria, between August 1990 and December 1993, and controls were drawn at random from the electoral roll, stratified by age and geographic region. Trained interviewers administered standard questionnaires to obtain detailed information about women's reproductive and contraceptive histories and other factors of interest, such as smoking and family history of ovarian or other cancer. Findings were based on data from 824 cases and 860 controls and confirmed the reduced risk of ovarian cancer associated with increasing parity and duration of use of the oral contraceptive pill (OCP), hysterectomy and tubal ligation. The strongest association of all was seen with use of the OCP for 10 years or more. An inverse association between ovarian cancer and age at first birth was observed, but this was not statistically significant. There were no associations between development of ovarian cancer and number of incomplete pregnancies, use of hormone replacement therapy or menstrual history. Among other factors considered, education after leaving school was negatively associated and high body mass index, family history of ovarian cancer, use of talc in the abdominal or perineal region and smoking were positively associated with occurrence of ovarian cancer.

Adolescent↗

PubMed1995

How accurate is self-reported family history of colorectal cancer?

Much of the evidence that supports a relation between a positive family history of and increased risk for colorectal cancer is based on information obtained exclusively from patients. There have been few assessments of the accuracy of such data. The validity of self-reported family history of colorectal cancer was assessed in the course of a case-control study of colorectal adenomas conducted among patients aged 20-75 years who underwent colonoscopy in Brisbane, Australia between 1980 and 1985. Family histories reported by a subsample of 237 colonoscopy patients (74 cases and 163 controls) were compared with relatives' medical records and death certificates. Patients' reports of colorectal cancer in 90 relatives were confirmed for 70 (77.8%; 95% confidence interval (CI) 67.8-85.9). Among 124 reports by patients of relatives who had other abdominal cancer or bowel conditions, 114 (91.9%; 95% CI 85.7-96.1) were confirmed to be correct, while 10 (8.1%) were found to be colorectal cancer. Finally, 105 (99.1%; 95% CI 94.9-100.0) of a random sample of 106 completely negative reports by patients were confirmed to be correct. Overall, 77% of positive family histories (any positive relatives) were confirmed, and it was estimated that 98% of negative family histories (no positive relatives) were correct. Cases were slightly more accurate than controls in reporting both positive and negative histories among their relatives. By extrapolation of these results to the total sample of 1,244 patients in the larger case-control study, sensitivity of self-reported positive family history was estimated to be 0.87 among cases and 0.82 among controls, and specificity was estimated to be 0.97 in both groups.

Adult↗

PubMed1995

Coronary heart disease mortality in Australia: is mortality starting to increase among young men?

BACKGROUND: There has been a major decline in mortality from coronary heart disease (CHD) in Australia from about 1967 through to 1989, occurring across all age groups simultaneously. We have analysed data up until 1992 to examine for trends within age cohorts. METHODS: Death registrations for acute myocardial infarction and CHD were used to construct male and female 5-year age- and cohort-specific mortality rates starting at 1900-1904 for cohorts and 25-29 years for age. Trends within age group and within cohort were compared across time. RESULTS: Across all female and most male birth cohorts there was a decrease in CHD mortality across the time period. In the youngest male cohorts there was a significant flattening in the rate of decline in the most recent periods. Comparison of age-specific mortality across cohorts showed the mortality at any period to be lower in the most recent cohort. CONCLUSIONS: This analysis demonstrates a continuing decline in mortality from CHD among females of all ages in Australia although the rate of decline appears to have slowed or even ceased in younger males.

Adult↗

PubMed1995

The incidence of melanocytic naevi in adolescent children in Queensland, Australia.

The aim of this study was to assess longitudinally the development of melanocytic naevi in children around the time of their puberty. In Queensland, Australia, 102 schoolchildren born mostly in 1977 or 1978, were examined annually on four occasions from 1990. All naevi on the body except for the scalp and parts covered by a bathing suit were counted by an experienced research nurse or trained assistant according to a set protocol. In addition, each subject's pigmentary characteristics were recorded and height, weight and pubertal status were assessed annually. The findings confirmed that the average number of naevi and average density of naevi (count per m2) on the whole body in boys and girls increase significantly with increasing age and increases were also seen on each of the following anatomic sites: face and neck, back and shoulders, and upper and lower limbs. Children who had a high baseline naevus count, or a large increase in skin surface area during the 3-year follow-up period had the highest absolute increases in naevus count but the smallest proportionate increases. Associations between baseline naevus counts and male sex, light brown or blonde hair, blue or hazel eyes, facial freckling and a tendency to sunburn, which have been previously reported, were also found. However, the independent relations of each of these factors to the increase in new naevi were more complex, once the effects of high naevus counts at baseline and increases in skin surface area were taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Training for rural general practice.

OBJECTIVE: To identify requirements for vocational training and continuing education programs in rural general practice. DESIGN: A questionnaire was sent to all 487 rural doctors and 140 metropolitan and 140 provincial city general practitioners (GPs) in Queensland. A sample of medical educators, health professional and consumer representatives and rural doctors was also interviewed. Responses were compared by geographical area, practice characteristics and level of postgraduate training. RESULTS: There are significant differences between rural and urban practice profiles. Rural doctors have to practise a range of clinical skills in an environment with restricted access to health professional support, although the need for advanced training in procedural or other skills depends on the type of rural practice. Rural and urban doctors want more influence in determining continuing medical education (CME) programs. Interactive learning methods were rated as the most effective education methods by both rural and urban GPs. Rural doctors were less likely to consider that they spent enough time on CME. CONCLUSION: Vocational training programs should accommodate various rural career objectives, including those requiring advanced levels of procedural work. There is a significant unmet demand for CME tailored to the needs of individual doctors, both rural and urban, but distance and isolation may make this more critical in rural practice. These issues need to be addressed as training opportunities can contribute to improved retention of the rural medical workforce.

Australia↗

PubMed1994

Do psycho-social factors contribute more to symptom reporting by middle-aged women than hormonal status?

Six hundred women aged between 45 and 54 were randomly selected from the electoral roll in Brisbane, Australia. A questionnaire addressing their symptoms, hormone status and psycho-social factors was successfully administered to 381 women (64% of the original sample; 83% of those contactable). Although cardiovascular symptoms were experienced by 25% of the sample, the most common (hot flushes) ranked only tenth on a list of recently experienced symptoms. The association of hormone status with symptoms was weak in comparison with other factors. Most symptoms were reported by women who were perimenopausal, had undergone a hysterectomy, or were currently using hormone replacement therapy. A poor mental health index was strongly associated with all groups reporting symptoms. It is concluded that clinicians responding to symptoms from middle-aged women should continue to address psychosocial factors just as vigorously as those related to their hormone status.

Attitude to Health↗

PubMed1994

Naevi in schoolchildren in Scotland and Australia.

To test the hypothesis that children living in subtropical and tropical environments have more naevi than those of similar ethnicity living in temperature countries, a comparative study of melanocytic naevi in 111 schoolchildren from Brisbane, Australia, and 222 from Glasgow, Scotland, was carried out. All children were aged 13-15 years, of European ancestry, and had spent most of their lives at latitudes of less than 30 degrees S (Australia) or greater than 30 degrees N (Scotland). Using an identical protocol, all naevi of 2 mm or more in diameter occurring on the right arm were counted by either a highly experienced research nurse in Brisbane, or a dermatologist in Glasgow. Hair and eye colour, and facial freckling, were assessed by the examiner, and axillary skin colour of children in both cities was measured using the same reflectance spectrophotometer. Children in Brisbane had significantly more naevi than those in Glasgow (P < 0.05), after adjusting for complexion variables. The difference in the geometric mean number of naevi on the arm was much greater among boys (7.7 vs. 4.4, in Brisbane and Glasgow, respectively) than among girls (7.3 vs. 6.7). This has parallels with the sex differences in melanoma at later ages in the two countries. Besides country of residence, freckles and innate skin colour were the most significant predictors of large numbers of naevi, whereas red hair had a significant protective effect. Overall, these data on prevalence of naevi in children from contrasting environments provide some evidence in support of the theory that naevus development is related to the level of sun exposure in childhood and adolescence.

Adolescent↗

PubMed1994

A sampling framework for rural and remote doctors.

A pilot survey by telephone interview, followed by a questionnaire of all rural doctors identified in Queensland, was used develop both a definition of rural practice that distinguishes it from urban general practice and a classification of rural and remote practice which assists in sampling of rural doctors. Questionnaire responses in specific geographic areas were compared using chi-square and Mantel-Haenszel chi-square tests. Several factors were found to differentiate rural from urban general practice consistently, thereby enabling a functional definition of rural practice to be developed. Within the broad group of rural doctors, gradients in practice characteristics were found to differentiate doctors in larger rural centres from those in smaller, more remote communities. These gradients were related to the distance and time of travel from support services. They formed the basis of a complex classification of rural and remote general practice. This functional definition of rural and remote medical practice should be considered by researchers of rural medicine issues when sampling rural and remote doctors. The strategies used in this study could be adapted for use in considering practice characteristics of other rural health professions.

Humans↗

PubMed1993

Relation between anthropometric indicators and risk of breast cancer among Australian women.

Associations between various anthropometric indicators and breast cancer were investigated in a community-based case-control study conducted among 456 premenopausal women (135 cases) and 656 women who were at least 10 years past menopause (185 cases) in Brisbane, Australia, from 1981 to 1985. Among postmenopausal women, increased risk was associated with greater weight at age 25 years (p trend = 0.002) and with a heavier maximum weight (p trend = 0.003), but not with recent weight. Results were similar for relative weight (weight (kg)/height (m)1.5). Overall, weight gain was unrelated to the occurrence of breast cancer, although risks were elevated among postmenopausal women who weighed less at age 25 (< 54 kg) and subsequently experienced a large weight gain (> 13 kg). Among premenopausal women, there was little indication that body size or change in weight was related to breast cancer. These results suggest that both heaviness in early adulthood and a large maximum weight at any time are associated with elevated risks for postmenopausal breast cancer.

Adult↗

PubMed1993

Diet and melanoma. An exploratory case-control study.

This population-based case-control study contrasted nutrient intakes of 41 women with cutaneous malignant melanoma to those of 297 women sampled from the same community (Brisbane, Australia). Diet was assessed by a comprehensive food frequency questionnaire. The strong inverse relation we observed between high intakes of polyunsaturated fatty acids and melanoma (P < 0.01) adds sufficient weight to prior findings for this persisting causal hypothesis to be abandoned. A relatively strong association with alcohol was observed: Women drinking 20 g or more (two or more drinks) daily had 2.5 (odds ratio) times the risk of melanoma as nondrinkers (95% confidence interval, 0.87 to 7.4). However, previous data are inconsistent. With regard to potential protective factors, our data fit with prior speculation that antioxidants (beta-carotene and vitamin E), zinc, and iron warrant further investigation. The nonsignificant (P = 0.18) 40% reduction in risk seen for those eating the most fish (> or = 15 g daily versus < 5 g) suggests the effects of marine oils and omega-3 fatty acids may deserve specific attention.

Adult↗

PubMed1993

Infant feeding in Queensland, Australia: long-term trends.

Infant feeding practices were retrospectively ascertained in a random cohort of parous women (mean age 54.8 years) from Brisbane, Australia. Reported proportions of infants who were ever breast-fed fell from around 90% before 1960 to around 70% in the early 1970s, with some subsequent increase. Similar but stronger trends were reported in proportions of infants breast- but not bottle-fed. Few maternal characteristics were associated with feeding practices, but women with more education appear to have led both the early retreat from and the later return to breast-feeding.

Bottle Feeding↗

PubMed1992

Prediction of hospital discharge in immediate survivors of ventricular fibrillation or asystole.

Survival from ventricular fibrillation and asystole is influenced by variables measured during resuscitation that affect both immediate survival and discharge from hospital. These variables have been used to develop a formula to calculate an individuals chances of immediate survival and hospital discharge. It has allowed this heterogenous group to be subdivided into groups which can be compared both within and between institutions for the purposes of audit and evaluation of resuscitation protocols. This study evaluates the addition of clinical parameters to the prognostic index. One hundred twelve immediate survivors of ventricular fibrillation or asystole were examined immediately after resuscitation and clinical parameters measured and recorded. At the same time parameters previously described were recorded. The increase in the numbers of survivors improved the reliability (area under the receiver operator curve (ROC) improved from 0.79 to 0.83) of the index for predicting hospital discharge. Addition of the clinical variables of conscious state, respiratory state, blood pressure and pulse rate improved the prognostic index further to an ROC area of 0.86. This ensures that the predictive power of the new index is now highly reliable for predicting hospital discharge after successful resuscitation from ventricular fibrillation and asystole.

Aged↗

PubMed1992

Socioeconomic status and mortality revisited: an extension of the Brisbane area analysis.

Using the methodology of an earlier study of socioeconomic mortality gradients, we partitioned Brisbane City into five strata of equal size on the basis of suburb scores derived from aggregate socioeconomic census data. Numbers of deaths by stratum, age, sex and cause were obtained from mortality files. For almost all causes, mortality gradients had not changed between 1976-1979 and 1980-1987. A new category, medically-preventable death under age 65, had lower rates in higher-ranking suburbs. Potential years of life lost (PYLL) per unit of population, age-standardised, were also computed by stratum and cause. External causes of death were the main contributors to PYLL among men, with a strong socioeconomic gradient, while neoplasms were most important among women, with little evidence of a social class effect. It is estimated that, in urban Australia, the annual number of additional deaths under age 65 due to socioeconomic circumstances is over 2000 for males and over 1000 for females. This study provides a baseline against which the programs of health advancement initiated in the mid-1980s may be evaluated, or conversely, the effects of societal changes assessed.

Adolescent↗