Socio-demographic factors associated with actual radiotherapy utilisation in New South Wales

Actual radiotherapy utilisation rates (A-RURs) tend to be lower than the estimated optimal rates (O-RURs) but little is known about the factors contributing to this difference. We aimed to compare A-RURs versus O-RURs and investigate the associations between an individual’s socio-demographic, socio-economic and health characteristics and receipt of radiotherapy, using the 45 and Up Study cancer population. We examined factors associated with radiotherapy for all cancers and two subgroups; prostate cancer and those with metastatic cancer on diagnosis (MCOD). In total, 267,153 participants aged ≥45 were enrolled in the population-based 45 and Up Cohort Study in New South Wales (NSW). Individuals completed a questionnaire during 2006-2009 providing health and socio-demographic information and consented to record linkage with administrative health datasets. Single primary cancers diagnosed after enrolment were identified through linkage with the NSW Cancer Registry. Radiotherapy receipt was determined from claims to the Medicare Benefits Schedule (MBS) and/or records in the NSW Admitted Patient Data Collection (APDC). For prostate cancer patients, radiation oncology consultations were determined using MBS claims and surgical receipt using MBS/APDC records. A-RURs were estimated using four different methods and compared to the Collaboration for Cancer Outcomes, Research and Evaluation (CCORE) O-RUR model. The CCORE model was adapted for patients with MCOD. Competing risks regression was used to examine associations between health and socio-demographic characteristics and treatment receipt. There were 17,873 patients with an incident cancer; 4003 had prostate cancer and 2392 had MCOD. In total, 5414 cancer patients received radiotherapy during a median follow-up time of 5.3 years. The A-RUR was 30-33% (compared with O-RUR of 48%); 32% for MCOD patients (45% O-RUR). Patients less likely to receive radiotherapy were aged =80 years, female, had co-morbidities, needed help with daily tasks or lived >=100 km from the nearest radiotherapy centre. Prostate cancer patients with private health insurance were less likely to undergo radiotherapy; 205/1628 (13%) of radical prostatectomy patients had a radiation oncology consultation prior to surgery. We demonstrated an underutilisation of radiotherapy with distinct subgroups of patients less likely to receive radiotherapy. Initiatives including education and policy changes are needed to improve utilisation

Issues and challenges in courseware development : a project managers perspective.

Many educational institutes venturing into courseware development to create online learning materials for their own students are often not aware of the challenges that lie ahead in managing courseware development projects. This paper highlights the potential challenges a courseware development project may face. It discusses lessons learnt from development projects carried out in Malaysia for content and language-based courses. Particularly, real cases will be presented to highlight challenges and the steps that were taken to overcome them within the constraints of time, budget, curriculum demands, client expectations, and competencies of content providers

Contributions of prognostic factors to socioeconomic disparities in cancer survival : protocol for analysis of a cohort with linked data

Introduction Socioeconomic disparities in cancer survival have been reported in many developed countries, including Australia. Although some international studies have investigated the determinants of these socioeconomic disparities, most previous Australian studies have been descriptive, as only limited relevant data are generally available. Here, we describe a protocol for a study to use data from a large-scale Australian cohort linked with several other health-related databases to investigate several groups of factors associated with socioeconomic disparities in cancer survival in New South Wales (NSW), Australia, and quantify their contributions to the survival disparities. Methods and analysis The Sax Institute's 45 and Up Study participants completed a baseline questionnaire during 2006-2009. Those who were subsequently diagnosed with cancer of the colon, rectum, lung or female breast will be included. This study sample will be identified by linkage with NSW Cancer Registry data for 2006-2013, and their vital status will be determined by linking with cause of death records up to 31 December 2015. The study cohort will be divided into four groups based on each of the individual education level and an area-based socioeconomic measure. The treatment received will be obtained through linking with hospital records and Medicare and pharmaceutical claims data. Cox proportional hazards models will be fitted sequentially to estimate the percentage contributions to overall socioeconomic survival disparities of patient factors, tumour and diagnosis factors, and treatment variables. Ethics and dissemination This research is covered by ethical approval from the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated to different interest groups and organisations through scientific conferences, social media and peer-reviewed articles

A healthy eating index to measure diet quality in pregnant women in Singapore: a cross-sectional study

10.1186/s40795-015-0029-3BMC Nutrition1391-11GUSTO (Growing up towards Healthy Outcomes

Variability in newborn telomere length is explained by inheritance and intrauterine environment

Background: Telomere length (TL) and its attrition are important indicators of physiological stress and biological aging and hence may vary among individuals of the same age. This variation is apparent even in newborns, suggesting potential effects of parental factors and the intrauterine environment on TL of the growing fetus. Methods: Average relative TLs of newborns (cord tissue, N = 950) and mothers (buffy coat collected at 26-28 weeks of gestation, N = 892) were measured in a birth cohort. This study provides a comprehensive analysis of the effects of heritable factors, socioeconomic status, and in utero exposures linked with maternal nutrition, cardiometabolic health, and mental well-being on the newborn TL. The association between maternal TL and antenatal maternal health was also studied. Results: Longer maternal TL (beta = 0.14, P = 1.99E-05) and higher paternal age (beta = 0.10, P = 3.73E-03) were positively associated with newborn TL. Genome-wide association studies on newborn and maternal TLs identified 6 genetic variants in a strong linkage disequilibrium on chromosome 3q26.2 (Tag SNP-LRRC34-rs10936600: P-meta = 5.95E-08). Mothers with higher anxiety scores, elevated fasting blood glucose, lower plasma insulin-like growth factor-binding protein 3 and vitamin B12 levels, and active smoking status during pregnancy showed a higher risk of giving birth to offspring with shorter TL. There were sex-related differences in the factors explaining newborn TL variation. Variation in female newborn TL was best explained by maternal TL, mental health, and plasma vitamin B12 levels, while that in male newborn TL was best explained by paternal age, maternal education, and metabolic health. Mother's TL was associated with her own metabolic health and nutrient status, which may have transgenerational effects on offspring TL. Conclusions: Our findings provide a comprehensive understanding of the heritable and environmental factors and their relative contributions to the initial setting of TL and programing of longevity in early life. This study provides valuable insights for preventing in utero telomere attrition by improving the antenatal health of mothers via targeting the modifiable factors.Peer reviewe

Associations of Maternal Dietary Patterns during Pregnancy with Offspring Adiposity from Birth Until 54 Months of Age

10.3390/nu9010002Nutrients91article no. 2GUSTO (Growing up towards Healthy Outcomes

The Growing Up in Singapore Towards Healthy Outcomes Study

Objective Epidemiological studies relating maternal 25-hydroxyvitamin D (25OHD) with gestational diabetes mellitus (GDM) and mode of delivery have shown controversial results. We examined if maternal 25OHD status was associated with plasma glucose concentrations, risks of GDM and caesarean section in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. Methods Plasma 25OHD concentrations, fasting glucose (FG) and 2-hour postprandial glucose (2HPPG) concentrations were measured in 940 women from a Singapore mother-offspring cohort study at 26–28 weeks’ gestation. 25OHD inadequacy and adequacy were defined based on concentrations of 25OHD ≤75nmol/l and >75nmol/l respectively. Mode of delivery was obtained from hospital records. Multiple linear regression was performed to examine the association between 25OHD status and glucose concentrations, while multiple logistic regression was performed to examine the association of 25OHD status with risks of GDM and caesarean section. Results In total, 388 (41.3%) women had 25OHD inadequacy. Of these, 131 (33.8%), 155 (39.9%) and 102 (26.3%) were Chinese, Malay and Indian respectively. After adjustment for confounders, maternal 25OHD inadequacy was associated with higher FG concentrations (β = 0.08mmol/l, 95% Confidence Interval (CI) = 0.01, 0.14), but not 2HPPG concentrations and risk of GDM. A trend between 25OHD inadequacy and higher likelihood of emergency caesarean section (Odds Ratio (OR) = 1.39, 95% CI = 0.95, 2.05) was observed. On stratification by ethnicity, the association with higher FG concentrations was significant in Malay women (β = 0.19mmol/l, 95% CI = 0.04, 0.33), while risk of emergency caesarean section was greater in Chinese (OR = 1.90, 95% CI = 1.06, 3.43) and Indian women (OR = 2.41, 95% CI = 1.01, 5.73). Conclusions 25OHD inadequacy is prevalent in pregnant Singaporean women, particularly among the Malay and Indian women. This is associated with higher FG concentrations in Malay women, and increased risk of emergency caesarean section in Chinese and Indian women

The Kynurenine Pathway Metabolites in Cord Blood Positively Correlate With Early Childhood Adiposity

Context The kynurenine pathway generates metabolites integral to energy metabolism, neurotransmission, and immune function. Circulating kynurenine metabolites positively correlate with adiposity in children and adults, yet it is not known whether this relationship is present already at birth. Objective In this prospective longitudinal study, we investigate the relationship between cord blood kynurenine metabolites and measures of adiposity from birth to 4.5 years. Methods Liquid chromatography-tandem mass spectrometry was used to quantify cord blood kynurenine metabolites in 812 neonates from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. Fat percentage was measured by air displacement plethysmography and abdominal adipose tissue compartment volumes; superficial (sSAT) and deep subcutaneous (dSAT) and internal adipose tissue were quantified by magnetic resonance imaging at early infancy in a smaller subset of neonates, and again at 4 to 4.5 years of age. Results Cord blood kynurenine metabolites appeared to be higher in female newborns, higher in Indian newborns compared with Chinese newborns, and higher in infants born by cesarean section compared with vaginal delivery. Kynurenine, xanthurenic acid, and quinolinic acid were positively associated with birthweight, but not with subsequent weight during infancy and childhood. Quinolinic acid was positively associated with sSAT at birth. Kynurenic acid and quinolinic acid were positively associated with fat percentage at 4 years. Conclusion Several cord blood kynurenine metabolite concentrations were positively associated with birthweight, with higher kynurenic acid and quinolinic acid correlating to higher percentage body fat in childhood, suggesting these cord blood metabolites as biomarkers of early childhood adiposity.Peer reviewe