RESUMEN
BACKGROUND: A substantial fall in high-density lipoprotein cholesterol (HDL-C) during puberty in boys, but not girls, has been reported in Western populations. The fall in boys is believed to be due to hormonal changes--androgens have been shown to be associated with lower HDL-C, whereas oestrogens are associated with higher HDL-C. The fall in HDL-C during puberty was not observed, however, in a study of Moslem boys in Israel, nor in a group of Japanese boys. A diet high in phyto-oestrogens may account for the lack of a fall in HDL-C in these populations. OBJECTIVE: To examine the effect of dietary supplementation with phyto-oestrogens on the HDL-C concentration of adolescent boys from a Western population. We hypothesised that dietary supplementation of 50 mg of the isoflavones daidzein and genistein would produce a 12% higher HDL-C concentration than in controls at the end of a 6-week intervention period. DESIGN: A randomised controlled trial. SETTING: Hellyer College in Burnie (Tasmania, Australia). SUBJECTS: Adolescent boys (aged 16-18 years) were recruited through a letter sent to parents. A total of 132 eligible participants enrolled and five subjects withdrew from the trial. RESULTS: No significant increase in HDL-C was observed in the treatment group (-0.02 mmol l(-1), standard error (SE)=0.03, P = 0.53) or the placebo group (0.05 mmol l(-1), SE = 0.03, P = 0.11). CONCLUSIONS: Factors other than isolated dietary isoflavones may be responsible for the lack of fall in HDL-C during puberty in Japanese and Moslem boys.
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Fenómenos Fisiológicos Nutricionales de los Adolescentes/fisiología , HDL-Colesterol/sangre , Isoflavonas/farmacología , Fitoestrógenos/farmacología , Pubertad/sangre , Adolescente/fisiología , Australia , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Comparación Transcultural , Servicios Dietéticos , Humanos , Israel , Japón , Masculino , Tasmania , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: Centralized prescription databases may provide an efficient mechanism for recruitment of community-treated disease. METHODS: The Australian federal government agency, the Health Insurance Commission (HIC), invited patients to participate in the Tasmanian Epilepsy Register (TER). Eligible patients included those who received at least one anticonvulsant above a 'reportable' price threshold between July 1, 2001 and June 30, 2002. Patients were asked to disclose their medical indication for anticonvulsant treatment with additional demographic and prescription information obtained from the HIC. RESULTS: 7,541 were eligible for recruitment. After two mail invitations over 6 months, 3,375 (46.6%) had responded, but TER enrollment amongst those indicating treatment for epilepsy was 1,180 (78.3%). TER participants were more likely to obtain their prescriptions exclusively from their general practitioner (70.9%) or from combined sources (19.1%) rather than from pediatrician (4.2%), neurologist (1.4%) or general physician (1.0%) sources. Patients were more likely to respond with increasing age (linear trend p < 0.001), when from a higher socioeconomic area (linear trend p < 0.001), or if their prescription was obtained from a neurologist (p < 0.001). CONCLUSION: The national Australian prescription database represents community-treated epilepsy and provides an effective and efficient method for patient recruitment for clinical epidemiological research.
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Anticonvulsivantes/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Epilepsia/epidemiología , Selección de Paciente , Sistema de Registros , Adulto , Factores de Edad , Estudios de Cohortes , Servicios de Salud Comunitaria/estadística & datos numéricos , Bases de Datos Factuales , Métodos Epidemiológicos , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Masculino , Medicina/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Vigilancia de la Población , Derivación y Consulta/estadística & datos numéricos , Factores Socioeconómicos , Especialización , TasmaniaRESUMEN
BACKGROUND: Human studies of dietary fat as a possible risk factor for cutaneous malignant melanoma (CMM) and non-melanoma skin cancer (NMSC)--principally basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)--have produced inconsistent results. We had the opportunity to examine the association concurrently for all three types of skin cancer in a population-based study in Tasmania, Australia, involving 652 cases of CMM, BCC and SCC and a common set of 471 controls. METHODS: Histopathologically-confirmed cases of CMM, BCC and SCC were ascertained from the Tasmanian Cancer Registry (TCR), and controls were selected at random from the state's electoral roll. We compared subjects categorised by thirds of dietary fat intake score measured by the 'Dobson short fat questionnaire', with logistic regression models that adjusted for age, sex, skin type and usual sun exposure. We then followed all subjects for 56-80 months until 31 August, 2004 for a new NMSC using record linkage with both the TCR and the Births, Deaths, and Marriages registry. Incidence rates were calculated and ratios of rates were estimated using Poisson models. RESULTS: Relative to subjects in the lowest fat intake category, the odds ratios (OR) comparing cases and controls were OR = 0.76 (95% CI: 0.56-1.03) for medium fat intake, and OR = 0.62 (95% CI: 0.45-0.85) for high fat intake, with a significant (p < 0.01) trend of reduced odds ratio with higher category dietary fat intake. Among cases, the incidence rate ratio (IRR) relative to those with lowest fat score was IRR = 0.72 (95% CI: 0.50-1.03) for medium fat intake, and IRR = 0.82 (95% CI: 0.56-1.20) for highest fat intake (linear trend p = 0.30). CONCLUSION: Using the same dietary instrument with two study designs in the same Caucasian population, we found no evidence that high fat intake increases the risk of developing melanoma or non-melanoma skin cancers. Instead, our results suggest a risk reduction for high fat intake.
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Carcinoma Basocelular/epidemiología , Carcinoma de Células Escamosas/epidemiología , Grasas de la Dieta/administración & dosificación , Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Adulto , Australia/epidemiología , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Factores de Riesgo , Neoplasias Cutáneas/diagnósticoRESUMEN
INTRODUCTION: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity for such use. We have evaluated their validity in detecting cognitive impairment not dementia (CIND) and dementia in a community-based sample of first-ever stroke patients. METHODS: The standardized MMSE (S-MMSE) and the 16-item IQCODE were administered to 79 patients 1 year after a first-ever stroke. CIND and dementia were diagnosed independently using a comprehensive cognitive battery. The performances of the two tests were evaluated using receiver operating characteristic (ROC) analyses. Combined performance was evaluated when their scores were used in parallel (the "or rule"), in series (the "and rule") or as a weighted sum (the "weighted sum rule"). RESULTS: Both tests were extremely poor at detecting CIND individually and in combination. For dementia, at traditional cut-points, the S-MMSE (< or =23) was insensitive (0.50, 95% CI 0.16-0.84) and the IQCODE (> or =3.30) nonspecific (0.63, 95% CI 0.51-0.75). An acceptable balance between sensitivity and specificity was achieved for dementia using the "or rule" combination, but with only modest positive predictive value. CONCLUSIONS: The S-MMSE and the IQCODE were individually poor at detecting CIND and dementia after a nonaphasic first-ever stroke. The combination was useful in detecting dementia but it does not replace the need for detailed neuropsychological tests.
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Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento/diagnóstico , Demencia/diagnóstico , Accidente Cerebrovascular/complicaciones , Anciano , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/etiología , Australia/epidemiología , Trastornos del Conocimiento/clasificación , Trastornos del Conocimiento/etiología , Demencia/clasificación , Demencia/etiología , Diagnóstico Diferencial , Humanos , Incidencia , Tamizaje Masivo/métodos , Pruebas Psicológicas , Análisis de Regresión , Reproducibilidad de los Resultados , Accidente Cerebrovascular/epidemiologíaRESUMEN
MELANOTAN (NDP-MSH) binds the MC1 receptor to significantly increase the eumelanin content of human skin cells. In this study of 77 Caucasian individuals, we investigated the effects of MELANOTAN in individuals with variant MC1R genotypes, as it has been suggested through in vitro studies that variant alleles decrease MELANOTAN binding efficacy, which would subsequently affect the synthesis of melanin. Administration of MELANOTAN produced a significant (p<0.001) increase in melanin density in treated, compared to placebo, individuals. Importantly, MELANOTAN increased the melanin density to a greater extent in individuals carrying the variant alleles Val60Leu, Asp84Glu, Val92Met, Arg142His, Arg151Cys, and Arg160Trp than in individuals with no variant alleles. This study demonstrates that MELANOTAN effectively increases the melanin content of skin in those individuals with MC1R variant alleles and therefore, those most in need of photoprotection.
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Alelos , Variación Genética , Melaninas/biosíntesis , Receptor de Melanocortina Tipo 1/efectos de los fármacos , Receptor de Melanocortina Tipo 1/genética , alfa-MSH/análogos & derivados , Método Doble Ciego , Humanos , Unión Proteica/genética , Resultado del Tratamiento , Población Blanca/genética , alfa-MSH/farmacologíaRESUMEN
OBJECTIVE: To resolve uncertainty regarding sex differences in osteoarthritis (OA) by performing a meta-analysis of sex differences in OA prevalence, incidence and severity. METHODS: Standard search strategies for population-based studies of OA providing sex-specific data. Random effects meta-analysis to provide pooled male vs female risk and rate ratios for prevalent and incident OA, and standardized mean differences (SMD) for OA severity. Meta-regression was used to investigate sources of heterogeneity. RESULTS: Males had a significantly reduced risk for prevalent OA in the knee [Risk Ratio (RR) 0.63, 95% CI 0.53-0.75] and hand [RR 0.81, 95% CI 0.73-0.90] but not for other sites. Males aged <55 years had a greater risk of prevalent cervical spine OA [RR 1.29, 95% CI 1.18-1.41]. Males also had significantly reduced rates of incident OA in the knee [Incidence Rate Ratio (IRR) 0.55, 95% CI 0.32-0.94] and hip [IRR 0.64, 95% CI 0.48-0.86], with a trend for hand [IRR 0.65, 95% confidence interval (CI) 0.35-1.20]. Females, particularly those > or = 55 years, tended to have more severe OA in the knee but not other sites. Heterogeneity in the estimates of sex differences in prevalence was substantially explained by age and other study design factors including method of OA definition. CONCLUSIONS: The results demonstrate the presence of sex differences in OA prevalence and incidence, with females generally at a higher risk. Females also tend to have more severe knee OA, particularly after menopausal age. The site differences indicate the need for further studies to explore mechanisms underlying OA.
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Osteoartritis/epidemiología , Factores de Edad , Anciano , Femenino , Articulaciones de la Mano , Humanos , Incidencia , Articulaciones/patología , Masculino , Persona de Mediana Edad , Osteoartritis/patología , Osteoartritis de la Rodilla/epidemiología , Prevalencia , Análisis de Regresión , Factores de Riesgo , Factores SexualesRESUMEN
OBJECTIVES: To examine whether the use of current prescribing software systems might raise rates of repeat prescribing, with a consequent increase in use of antibiotics in the community. DESIGN AND SETTING: A prospective audit of consecutive prescriptions for amoxycillin, cefaclor, roxithromycin and amoxycillin/clavulanate presented to community pharmacies in the Hunter region of New South Wales and a follow-up survey of people who received a repeat prescription, October to November 2000. MAIN OUTCOME MEASURES: The frequency of repeat prescription ordering on computer-generated and handwritten prescriptions; the proportion of people who filled their repeat prescription. RESULTS: Data were collected for 1667 prescriptions presented to 35 pharmacies; 126 people who received repeat prescriptions completed the survey. The rate of repeat prescription ordering on computer-generated prescriptions was 69%, compared with 40% for handwritten prescriptions (odds ratio, 3.3; 95% CI, 2.6-4.2). Computer-generated repeat prescriptions were as likely to be filled as hand-written prescriptions (61% and 69%, respectively). CONCLUSIONS: The default settings on computerised prescribing packages result in a significant increase in the use of antibiotics. We estimate these settings result in about 500 000 additional prescriptions being filled annually in Australia for the four antibiotics in the study.
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Antibacterianos/uso terapéutico , Sistemas de Registros Médicos Computarizados , Pautas de la Práctica en Medicina/estadística & datos numéricos , Servicios de Información sobre Medicamentos , Encuestas de Atención de la Salud , Humanos , Auditoría Médica , Nueva Gales del Sur , Farmacéuticos , Programas InformáticosRESUMEN
OBJECTIVES: To derive indicators of quality prescribing by Australian general practitioners based on Health Insurance Commission (HIC) data and assess the influence of incomplete capture of data on under-copayment drugs on the validity of these indicators. DESIGN: Two expert groups proposed prescribing indicators that can be derived from aggregate prescribing data, and which reflect important clinical or cost-effectiveness issues. Indicators were examined using HIC data and compared with national prescribing trends over time using Australian Statistics on Medicines. The effect of incomplete data capture on indicator interpretation was examined by stratifying GPs into five strata based on the proportion of concession card holders in their practice. PARTICIPANTS: Approximately 14,000 Australian GPs providing > or = 1500 Medicare services per year. MAIN OUTCOME MEASURES: Measures of prescribing for individual GPs (based on HIC data 1993-1997). RESULTS: Forty-three potentially useful indicators were identified. These covered a fairly narrow range of prescribing activities and many required additional clinical information for interpretation. Indicators based on prescribing rates gave a misleading picture of prescribing trends where the extent of HIC data capture changed over time. Indicators expressed as ratios that reflected choice of agent within a drug class were less affected by incomplete data capture. CONCLUSIONS: Indicators of quality prescribing can be derived from HIC data. However, indicators for under-copayment drugs that represent prescribing rates may unfairly classify doctors practising in areas of socioeconomic disadvantage or high morbidity as "high prescribers". Ratio indicators are more robust, and may be more valid prescribing measures. If HIC data are to be used to monitor the quality of prescribing, data on all prescriptions dispensed will be needed.