Affective disorders, psychosis and dementia in a community sample of older men with and without Parkinson's disease

Background: Dementia and affective and psychotic symptoms are commonly associated with Parkinson's disease, but information about their prevalence and incidence in community representative samples remains sparse. Methods: We recruited a community-representative sample 38173 older men aged 65-85 years in 1996 and used data linkage to ascertain the presence of PD, affective disorders, psychotic disorders and dementia. Diagnoses followed the International Classification of Disease coding system. Age was recorded in years. Follow up data were available until December 2011. Results: The mean age of participants was 72.5 years and 333 men (0.9%) had PD at study entry. Affective and psychotic disorders and dementia were more frequent in men with than without PD (respective odds ratios: 6.3 [95%CI = 4.7, 8.4]; 14.2 [95%CI = 8.4, 24.0] and 18.2 [95%CI = 13.4, 24.6]). Incidence rate ratios of affective and psychotic disorders were higher among men with than without PD, although ratios decreased with increasing age. The ageadjusted hazard ratio (HR) of an affective episode associated with PD was 5.0 (95%CI = 4.2, 5.9). PD was associated with an age-adjusted HR of 8.6 (95%CI = 6.1, 12.0) for psychotic disorders and 6.1 (95%CI = 5.5, 6.8) for dementia. PD and dementia increased the HR of depressive and psychotic disorders. Conclusions: PD increases the risk of affective and psychotic disorders, as well as dementia, among community dwelling older men. The risk of a recorded diagnosis of affective and psychotic disorders decreases with increasing age

High-sensitivity cardiac troponin I improves cardiovascular risk prediction in older men: HIMS (The Health in Men Study)

Background: The Framingham Risk Score estimates the 10-year risk of cardiovascular events. However, it performs poorly in older adults. We evaluated the incremental benefit of adding high-sensitivity cardiac troponin I (hs-cTnI) to the Framingham Risk Score. Methods and Results: The HIMS (Health in Men Study) is a cohort study of community-dwelling men aged 70 to 89 years in Western Australia. Participants were identified from the electoral roll, with a subset undergoing plasma analysis. Hs-cTnI (Abbott Architect i2000SR) was measured in 1151 men without prior cardiovascular disease. The Western Australia Data Linkage System was used to identify incident cardiovascular events. After 10 years of follow-up, 252 men (22%) had a cardiovascular event (CVE+) and 899 did not (CVE–). The Framingham Risk Score placed 148 (59%) CVE+ and 415 (46%) CVE– in the high-risk category. In CVE– men, adding hs-cTnI affected the risk categories of 244 (27.2%) men, with 64.8% appropriately reclassified to a lower and 35.2% to a higher category, which decreased the number of high-risk men in the CVE– to 39%. In CVE+ men, adding hs-cTnI affected the risk categories of 61 (24.2%), with 50.8% appropriately reclassified to a higher and 49.2% to a lower category and 82.5% remaining above the 15% risk treatment threshold. The net reclassification index was 0.305 (P<0.001). Adding hs-cTnI increased the C-statistic modestly from 0.588 (95% CI, 0.552–0.624) to 0.624 (95% CI, 0.589–0.659) and improved model fit (likelihood ratio test, P<0.001). Conclusions: Adding hs-cTnI to the Framingham Risk Score provided incremental prognostic benefit in older men, especially aiding reclassification of individuals into a lower risk category

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Bilateral breast cancer incidence and survival

Introduction - This study re - examined the epidemiology of bilateral breast cancer with regard to the age at diagnosis and histology of the first breast cancer, and examined the effect of bilateral breast cancer on breast cancer survival. Methods - A cohort of US women with breast cancer was identified using cancer registry data for the period 1973 to 2000 obtained from the Surveillance, Epidemiology, and End Results ( SEER ) Program. In this cohort, incidence cases of bilateral breast cancer were identified and rates calculated per 1,000 person - years and the effect on survival of a diagnosis of a bilateral breast cancer was determined using time - dependent proportional hazard regression. Results - The overall incidence of bilateral breast cancer was 5.5 per 1,000 person - years and, apart from an elevation in incidence in the first year, was constant over time. In age - cohorts of young women, age - specific rates of bilateral breast cancer were found to decline as these women aged, approaching the incidence observed in older age cohorts. In older age - cohorts, age - specific rates were comparatively constant until age 75 - 79 years, after which age - specific rates began to decline regardless of age at first diagnosis.Differences in the crude incidence of bilateral breast cancer in sub - cohorts of women with lobular carcinoma ( 6.56 per 1,000 person - years ) and infiltrating ductal carcinoma ( 5.31 per 1,000 person - years ) were largely explained by differential incidence in the first year following diagnosis of the first breast cancer. Diagnosis of bilateral breast cancer increased the risk of breast cancer mortality, independent of the interval between the first and second breast cancer. Stage of both the first and second breast cancers was found to be the most important determinant of risk. Conclusions - This study found that the pattern of age - specific incidence of bilateral breast cancer was consistent with effects already well established in the literature describing the incidence of first primary breast cancer - pre - menopausal effects in young women and underascertainment in older women. Estimates of the incidence of bilateral breast cancer were subject to bias caused by an elevation in the incidence in the first year following diagnosis of the first breast cancer. This was most likely an effect of increased surveillance. This explained to a large extent, associations between the histology of the first breast cancer and the incidence of bilateral breast cancer observed in earlier studies. This study challenged the currently accepted view that bilateral breast cancer was a sign of increased susceptibility to breast cancer. Instead it is argued that the constant annual incidence of bilateral breast cancer suggests a final, discrete stage in a multistage carcinogenesis process. It is further argued that the observed incidence of bilateral breast cancer allows us to estimate the incidence of breast cancer in the population among women reaching this final stage within their lifetime. It is conservatively estimated that by age 75 to 79 years only half the women in the population have reached this final stage. This implies that in half the population of women, breast cancer either never initiates or progresses so slowly that the final stage of carcinogenesis is not reached within their lifetime.Thesis (Ph.D.) -- University of Adelaide, School of Population Health and Clinical Practice, 2006

Road accident statistics

Article first published online: 12 FEB 2010This book is unique. It is the first comprehensive and detailed documentation of the processes that are followed in the collection of road accident data. The book has 14 chapters: the first two present data on road accident fatalities from 150 countries; five deal with police accident data; six with injury classification methods and their use by police, hospitals and coroners; and one with insurance data. The relevant literature from a large number of countries is examined, although most of the detailed information comes from Australia, Britain and the USA

Publicity, police resources and the effectiveness of random breath testing

Kieran A. McCaul and A. John McLea

Effectiveness of random breath testing related to enforcement level and publicity

K.A. McCaul & A.J. McLea

Risk of suicide in cancer patients in Western Australia, 1981-2002

OBJECTIVE: To describe the incidence and risk of suicide in cancer patients in Western Australia from 1981 to 2002. DESIGN, SETTING AND PATIENTS: Retrospective cohort study of patients diagnosed with cancer in WA from 1981 to 2002, using data from the WA Linked Database. MAIN OUTCOME MEASURE: Age-standardised mortality ratios (SMRs). RESULTS: A total of 121 533 patients were diagnosed with cancer, corresponding to a total of 543 696 person-years at risk. There were 129 suicides in this group (108 in men). The SMR for suicide in cancer patients was 1.61 (95% CI, 1.36-1.92). An initial period of peak risk was seen in the first 3 months after cancer diagnosis (SMR, 5.75; 95% CI, 3.89-8.51), mainly in patients with a poor prognosis. A second peak period of risk was found to occur 12-14 months after diagnosis (SMR, 2.33; 95% CI, 1.11-4.89) in those with a good or moderate prognosis. CONCLUSION: The rate of suicide in cancer patients in WA is low and represents an excess of two to three suicides per year, or 0.3% of all cancer deaths, comparable to studies in other Western countries. The risk is highest in the first 3 months after diagnosis, and a second period of increased risk 12-14 months after diagnosis may occur in response to cancer recurrence or treatment failure