Health, social roles and the life course : a study of Australian women born between 1926 and 1966

This study investigated the relationships between Aush-alian women's social-role and health careers. Most previous studies have used current-status measures of role participation. It is a premise of this stiidy that these current-statiis indicators are unsatisfactory because they poorly reflect social-role careers. As an alternative, this study adopted a life-course approach where early-adulthood social-role structures are thought to govern \he rest of the life course by conditioning the types of experience that people are likely to encounter, suggesting that there is a sti-ong emphasis on widespread patterns of maintenance and equilibrium that continuously convert circumstances from early to later life-course phases. The analysis primarily used Australian Family Project (AFP) data collected in 1986-87 combined with follow-up data gathered in 1990 from women who were living in Sydney at the time of the first survey (n=291). Where possible a supporting analysis was carried out using AFP data for metropolitan Australia (n=1678). Respondents were aged between 20 and 59 years at the baseline. The health indicators of the study include histories of self-reported serious chronic disease, psychological distress (GHQ) and self-rated health. Social-role careers were reconstructed from recalled event-history data starting at exact age 20 years. The main results indicate that early-adulthood social-role careers are significantly related to subsequent social and health statuses. Regardless of cohort, women who experienced varied role combinations between the ages 20 and 29 years, in particular those spending most of this time not employed, tended to have a lower risk of chronic disease over the subsequent course of their lives than women who followed more uniform careers, especially those who spent most of their 20s employed while rearing children. Variability in women's social careers after age 30 years had little effect on chronic disease risk for the majority of early-adulthood groups, although women who delayed marriage and a 'traditional' career (not employed, married with children) until late in early adulthood substantially increased their risk of disease. In relation to psychological distress and self-rated health, women bom between 1946 and 1956 who followed a traditional career during most of their 20s tended to have higher levels of psychological distress and to rate their health worse at the time of the Follow-up Survey than their non-traditional counterparts. On the other hand, older women who spent most of their 20s in a traditional career tended to have the best mental health, while those who had three or more children rated their health the best. It was also found that chronic disease significantly affects role participation. Respondents who developed a long-standing chronic condition early in life were more likely to have had fewer children, and to have been separated, divorced or widowed With regard to employment, the effects are more complex: for older women (born 1926-46), the influence of chronic disease changes over the life course. At young ages those with a childhood chronic disease were more likely to have been continually employed while 'healthy' women were selected out of the work force to start a family. In contrast, middle age saw those with chronic disease more likely either to remain out of the labour force or leave it. The younger cohort (bom 1946-66) showed a 'healthy worker' effect much earlier than the older cohort: those who had a chronic disease were more likely to have remained out of the work force or experienced multiple employment-status transitions. In conclusion, the present study has offered an innovative approach to examining the relationships between social-role and health careers. The findings have provided support for the notion that early-adulthood social-role careers for women are important determinants of their subsequent health status; and that social selection occurs at most stages of the life course and is probably influenced by social and economic changes. Such findings have far-reaching implications in terms of government policies, suggesting that governments look beyond the socio-economically disadvantaged to broader indicators of women's social careers. In relation to research, advancing technology, and larger and more comprehensive longitudinal data sets will enable other life-course studies to bring us closer to understanding why and how social forces are associated with the health status of people

The development of the Canberra symptom scorecard: a tool to monitor the physical symptoms of patients with advanced tumours

BACKGROUND: Patients with advanced (incurable) tumours usually experience a diverse burden of symptoms. Although many symptom assessment instruments are available, we examined whether these addressed tumour-related symptoms. METHODS: We reviewed existing symptom assessment instruments and found a number of deficiencies such as instruments being too long or burdensome, too short, or measuring quality of life rather than tumour-related symptoms. Others focused on emotional, rather than physical symptoms. Therefore, we decided to devise a new symptom instrument. A list of 20 symptoms common in patients with advanced tumours generated from the literature and existing instruments, was ranked according to prevalence by 202 Australian clinicians. Following clinicians' responses, the list was revised and two severity assessment scales (functional severity and distress severity) added. The resultant 18-item list was assessed in 44 outpatients with advanced tumours. RESULTS: Patient responses indicated that a shorter questionnaire of 11 items, reflecting three main symptom clusters, provided a good representation of physical symptoms. An additional symptom that is an important predictor of survival was added, making a 12-item questionnaire, which was entitled "The Canberra Symptom Scorecard" (CSS). For symptom severity, the distress severity scale was more appropriate than the functional severity scale. CONCLUSION: The CSS focuses on tumour-related physical symptoms. It is about to be assessed in patients with advanced tumours receiving palliative treatments, when it will also be validated against existing instruments

Medical Journal of Australia

ABSTRACT Objectives: To determine the response to colorectal cancer (CRC) screening by colonoscopy, through direct invitation or through invitation by general practitioners. Design and setting: Two-way comparison of randomised population sampling versus cluster sampling of a representative general practice population in the Australian Capital Territory, May 2002 to January 2004. Intervention: Invitation to screen, assessment for eligibility, interview, and colonoscopy. Subjects: 881 subjects aged 55-74 years were invited to screen: 520 from the electoral roll (ER) sample and 361 from the general practice (GP) cluster sample. Main outcome measures: Response rate, participation rate, and rate of adenomatous polyps in the screened group. Results: Participation was similar in the ER arm (35.1%; 95% CI, 30.2%-40.3%) and the GP arm (40.1%; 95% CI, 29.2%-51.0%) after correcting for ineligibility, which was higher in the ER arm. Superior eligibility in the GP arm was offset by the labour of manual record review. Response rates after two invitations were similar for the two groups (ER arm: 78.8%; 95% CI, 75.1%-82.1%; GP arm: 81.7%; 95% CI, 73.8%-89.6%). Overall, 53.4% ineligibility arose from having a colonoscopy in the past 10 years (ER arm, 98/178; GP arm, 42/84). Of 231 colonoscopies performed, 229 were complete, with 32% of subjects screened having adenomatous polyps. Conclusions: Colonoscopy-based CRC screening yields similar response and participation rates with either random population sampling or general practice cluster sampling, with population sampling through the electoral roll providing greater ease of MJA 2004; 181: 423-427 recruitment

Colonoscopic screening for colorectal cancer improves quality of life measures: a population-based screening study

BACKGROUND: Screening asymptomatic individuals for neoplasia can have adverse consequences on quality of life. Colon cancer screening is widespread but the quality of life (QOL) consequences are unknown. This study determined the impact of screening colonoscopy on QOL measures in asymptomatic average-risk participants. METHODS: Asymptomatic male and female participants aged 55–74 years were randomly selected from the Australian Electoral Roll or six primary care physicians' databases. Participants completed the Short-Form (SF-36) Quality of Life Assessment at baseline and at a mean of 39 days after colonoscopy. Outcome measures were (i) significant changes in raw scores in any of the eight SF-36 domains assessed following colonoscopic screening and (ii) improvements or declines in previously validated categories, representing clinically significant changes, within any of the eight SF-36 domains. RESULTS: Baseline QOL measures were similar to those of a matched general population sample. Role Limitations due to Emotions, Mental Health and Vitality raw scores significantly improved following colonoscopy (P < 0.05, 2-tailed t-test). Health ratings according to Category were similar (same clinical status) in the majority of participants. However, 30% participants recorded clinically significant improvement in the Mental Health and Vitality domains (P < 0.05, Wilcoxon Signed-Ranks test). This improvement was not offset by declines in other domains or in other participants. Improvement in QOL was not related to colonoscopy results. CONCLUSION: Average-risk persons benefit significantly from colon cancer screening with colonoscopy, improving in Mental Health and Vitality domains of Quality of Life. This improvement is not offset by declines in other domains

Routine use of ancillary investigations in staging diffuse large B-cell lymphoma improves the International Prognostic Index (IPI)

<p>Abstract</p> <p>Background</p> <p>The International Prognostic Index (IPI) is used to determine prognosis in diffuse large B-cell lymphoma (DLBCL). One of the determinants of IPI is the stage of disease with bone marrow involvement being classified as stage IV. For the IPI, involvement on bone marrow is traditionally defined on the basis of histology with ancillary investigations used only in difficult cases to aid histological diagnosis. This study aimed to determine the effect of the routine use of flow cytometry, immunohistochemistry and molecular studies in bone marrow staging upon the IPI.</p> <p>Results</p> <p>Bone marrow trephines of 156 histologically proven DLBCL cases at initial diagnosis were assessed on routine histology, and immunohistochemistry using two T-cell markers (CD45RO and CD3), two B-cell markers (CD20 and CD79a) and kappa and lambda light chains. Raw flow cytometry data on all samples were reanalysed and reinterpreted blindly. DNA extracted from archived paraffin-embedded trephine biopsy samples was used for immunoglobulin heavy chain and light chain gene rearrangement analysis. Using immunophenotyping (flow cytometry and immunohistochemistry), 30 (19.2%) cases were upstaged to stage IV. A further 8 (5.1%) cases were upstaged using molecular studies. A change in IPI was noted in 18 cases (11.5%) on immunophenotyping alone, and 22 (14.1%) cases on immunophenotyping and molecular testing. Comparison of two revised IPI models, 1) using immunophenotyping alone, and 2) using immunophenotyping with molecular studies, was performed with baseline IPI using a Cox regression model. It showed that the revised IPI model using immunophenotyping provides the best differentiation between the IPI categories.</p> <p>Conclusion</p> <p>Improved bone marrow staging using flow cytometry and immunohistochemistry improves the predictive value of the IPI in patients with DLBCL and should be performed routinely in all cases.</p

Anatomic single-bundle anterior cruciate ligament reconstruction reduces both anterior translation and internal rotation during the pivot shift

Background: The ability of single-bundle anterior cruciate ligament (ACL) reconstruction to restore rotational control has been questioned by proponents of the double-bundle technique. The term anatomic positioning has become popularized in recognition of the incorrect positioning sometimes used in the past, which may have contributed to the lack of rotation control. The pivot-shift test remains the most clinically useful measure of ACL deficiency, and it is now possible to measure it both accurately and objectively using computer navigation. Hypothesis: Single-bundle ACL reconstruction will reduce anterior translation and internal rotation of the tibia during the pivotshift test when compared with the contralateral uninjured knee. Study Design: Descriptive laboratory study. Methods: A total of 20 patients with an acute isolated ACL rupture underwent reconstruction with a single-bundle autologous hamstring graft. Computer navigation was used intraoperatively to plot the pivot shift before and after reconstruction. The opposite uninjured knee was used as a control. Statistical analysis was used to compare the pivot shifts before and after surgery. Results: Single-bundle ACL reconstruction produced a significant reduction in anterior translation, from a mean ± SD of 17.4 ± 3.80 mm to 6.4 ± 1.95 mm (P<.001), as well as in internal rotation, from 22.9° ± 5.91° to 7.5° ± 2.96° (P<.001). The anterior translation in the reconstructed knees was similar to the control knees, 6.4 ± 1.95 mm versus 5.6 ± 1.23 mm (P<.148), while the internal rotation was significantly less in the reconstructed knees, 7.5° ± 2.96° versus 11.9° ± 3.36° (P<.05). The values for the coupled movements were used to calculate the length of the radius of curvature, about which the tibia rotates relative to the femur, during the pivot shift. In the control knees, the mean value was 28.9 ± 8.21 mm, while there was extreme variability in the operated knee both before and after surgery. Conclusion: It is possible to reduce both anterior translation and internal rotation, which occur during the pivot-shift test in the ACL-deficient knee, using single-bundle ACL reconstruction, when measured at the time of surgery. However, normal motion is not fully restored

Randomized controlled trial of accelerated rehabilitation versus standard protocol following surgical repair of ruptured Achilles tendon

Background: There is no consensus regarding the optimal management of the acutely ruptured Achilles tendon (TA). Functional bracing alone achieves outcomes similar to those of surgical repair. Surgical repair combined with immediate mobilization may improve the clinical outcome further. The purpose of our study was to determine if an accelerated rehabilitation programme following surgical repair of the ruptured TA could improve clinical outcome, relative to the standard protocol. Methods: Patients with an acutely ruptured TA were randomly allocated to undergo an accelerated programme (AP) or standard programme (SP), following surgery. Outcome was assessed at 12 months post-surgery using the Achilles tendon Total Rupture Score (ATRS), the heel-raise height and the time taken to return to running. Results: Fifty-one patients completed the study, 25 in the AP group and 26 in the SP group. At 12 months post-surgery, the ATRS results were similar in the two treatment groups (87.46 in AP with standard error (SE) of 0.735 versus 87.12 in SP with SE of 0.75) while the AP group had less lengthening of the TA (0.385cm, SE 0.166 versus 1.00cm, SE 0.169) and a more rapid return to running (17.231 weeks, SE 0.401 versus 21.08 weeks, SE 0.409), than the SP group. Conclusion: The accelerated rehabilitation programme resulted in less tendon lengthening, more rapid return to running, but similar ATRS relative to the standard rehabilitation. Immobilization following TA repair may prolong recovery