The burden of cancer attributable to modifiable risk factors: The Australian cancer-PAF cohort consortium

Purpose To estimate the Australian cancer burden attributable to lifestyle-related risk factors and their combinations using a novel population attributable fraction (PAF) method that accounts for competing risk of death, risk factor interdependence and statistical uncertainty. Participants 365 173 adults from seven Australian cohort studies. We linked pooled harmonised individual participant cohort data with population-based cancer and death registries to estimate exposure-cancer and exposure-death associations. Current Australian exposure prevalence was estimated from representative external sources. To illustrate the utility of the new PAF method, we calculated fractions of cancers causally related to body fatness or both tobacco and alcohol consumption avoidable in the next 10 years by risk factor modifications, comparing them with fractions produced by traditional PAF methods. Findings to date Over 10 years of follow-up, we observed 27 483 incident cancers and 22 078 deaths. Of cancers related to body fatness (n=9258), 13% (95% CI 11% to 16%) could be avoided if those currently overweight or obese had body mass index of 18.5–24.9 kg/m2. Of cancers causally related to both tobacco and alcohol (n=4283), current or former smoking explains 13% (11% to 16%) and consuming more than two alcoholic drinks per day explains 6% (5% to 8%). The two factors combined explain 16% (13% to 19%): 26% (21% to 30%) in men and 8% (4% to 11%) in women. Corresponding estimates using the traditional PAF method were 20%, 31% and 10%. Our PAF estimates translate to 74 000 avoidable body fatness-related cancers and 40 000 avoidable tobacco- and alcohol-related cancers in Australia over the next 10 years (2017–2026). Traditional PAF methods not accounting for competing risk of death and interdependence of risk factors may overestimate PAFs and avoidable cancers. Future plans We will rank the most important causal factors and their combinations for a spectrum of cancers and inform cancer control activities.This study was funded by the National Health and Medical Research Council (ID1060991; ID1053642 to MAL; ID1082989 to KC; ID1042717 to EB) and a Cancer Institute New South Wales Fellowship (ID13/ECF/1-07 to MAL). Maria Arriaga was supported by Australian Postgraduate Award and a Translational Cancer Research Network (TCRN) PhD Scholarship Top-up Award

Diet and cataract: the Blue Mountains Eye Study

Purpose: To investigate relationships between a wide range of macro- and micronutrients, including antioxidant vitamins, and the three main types of cataract in older people. Design: Population-based cross-sectional study. Participants: Two thousand nin

Dietary sodium intake and cataract: the Blue Mountains Eye Study

A population-based cross-sectional study (n = 2,873) was conducted near Sydney, Australia, from January 1992 to January 1994 to assess the relation between dietary sodium intake and risk of cataract. Photographs of subjects' lenses were graded for cortical, nuclear, and posterior subcapsular cataracts. Dietary sodium intake was assessed with a food frequency questionnaire. The study found that higher sodium intakes were associated with greater risk of posterior subcapsular cataract (p for trend = 0.006). The adjusted relative risk was 2.0 (95% confidence interval: 1.2, 3.4) for subjects in the highest versus the lowest quintile of sodium intake. These findings suggest that a high- salt diet may increase the risk of posterior subcapsular cataract

Prescribing in Older People

BACKGROUND: Prescribing medications to older people is difficult due to comorbidity, limited evidence for efficacy, increased risk of adverse drug reactions, polypharmacy, and altered pharmacokinetics. OBJECTIVE: This article describes the principles underlying clinical geriatric pharmacology including approaches to evaluating the evidence for risk and benefit, and adjusting dose for age related pharmacokinetic changes. DISCUSSION: The challenge for the general practitioner is to balance an incomplete evidence base for efficacy in frail, older people against the problems related to adverse drug reactions without denying older people potentially valuable pharmacotherapeutic interventions

Southland Video Anthology, 1976-77

This catalogue documents the video work of 44 American and Canadian videomakers as it appeared in a series of four exhibitions. Includes artist's statements and brief biographical notes

Diet quality and its implications on the cardio-metabolic, physical and general health of older men: The Concord Health and Ageing in Men Project (CHAMP)

The revised Dietary Guideline Index (DGI-2013) scores individuals’ diets according to their compliance with the Australian Dietary Guideline (ADG). This cross-sectional study assesses the diet quality of 794 community-dwelling men aged 74 years and older, living in Sydney, Australia participating in the Concord Health and Ageing in Men Project; it also examines sociodemographic and lifestyle factors associated with DGI-2013 scores; it studies associations between DGI-2103 scores and the following measures: homoeostasis model assessment – insulin resistance, LDLcholesterol, HDL-cholesterol, TAG, blood pressure, waist:hip ratio, BMI, number of co-morbidities and medications and frailty status while also accounting for the effect of ethnicity in these relationships. Median DGI-2013 score was 93·7 (54·4, 121·2); most individuals failed to meet recommendations for vegetables, dairy products and alternatives, added sugar, unsaturated fat and SFA, fluid and discretionary foods. Lower education, income, physical activity levels and smoking were associated with low scores. After adjustments for confounders, high DGI-2013 scores were associated with lower HDL-cholesterol, lower waist:hip ratios and lower probability of being frail. Proxies of good health (fewer comorbidities and medications) were not associated with better compliance to the ADG. However, in participants with a Mediterranean background, low DGI-2013 scores were not generally associated with poorer health. Older men demonstrated poor diet quality as assessed by the DGI-2013, and the association between dietary guidelines and health measures and indices may be influenced by ethnic background

The value of comparing health outcomes in cohort studies: An example of self-rated health in seven studies including 79 653 participants

Objective: To demonstrate the value of comparing data from multiple cohort studies using the example of self-rated health (SRH). Methods: Seven Australian cohort studies including comparable data on SRH were identified. Comparisons of the distributions of SRH were conducted, and logistic regression was used to evaluate age, sex and education effects within studies. A nationally representative survey was used as a statistical reference to determine how studies differed from the Australian population in frequencies of responses. Results: Ratings of SRH declined with increasing age. Low education was associated with higher frequencies of fair/poor SRH even in young adulthood but there were no sex differences. Results for smaller studies did not necessarily differ from nationally representative studies. Conclusion: Collaborative reanalysis of Australian cohort permits analysis of health outcomes from a large numbers of participants. Health outcomes and their sociodemographic determinants may be more comprehensively evaluated through such collaborative projects