Lifetime risk of prostate cancer overdiagnosis in Australia: Quantifying the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach

© 2019 Author(s). Objectives To quantify the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach. Design Modelling and validation of the lifetime risk method using publicly available population data. Setting Opportunistic screening for prostate cancer in the Australian population. Participants Australian male population (1982-2012). Interventions Prostate-specific antigen testing for prostate cancer screening. Primary and secondary outcome measures Primary: Lifetime risk of overdiagnosis in 2012 (excess lifetime cancer risk adjusted for changing competing mortality); Secondary: Lifetime risk of prostate cancer diagnosis (unadjusted and adjusted for competing mortality); Excess lifetime risk of prostate cancer diagnosis (for all years subsequent to 1982). Results The lifetime risk of being diagnosed with prostate cancer increased from 6.1% in 1982 (1 in 17) to 19.6% in 2012 (1 in 5). Using 2012 competing mortality rates, the lifetime risk in 1982 was 11.5% (95% CI 11.0% to 12.0%). The excess lifetime risk of prostate cancer in 2012 (adjusted for changing competing mortality) was 8.2% (95% CI 7.6% to 8.7%) (1 in 13). This corresponds to 41% of prostate cancers being overdiagnosed. Conclusions Our estimated rate of overdiagnosis is in agreement with estimates using other methods. This method may be used without the need to adjust for lead times. If annual (cross-sectional) data are used, then it may give valid estimates of overdiagnosis once screening has been established long enough for the benefits from the early detection of non-overdiagnosed cancer at a younger age to be realised in older age groups

Factors associated with stress among first-year undergraduate students attending an Australian university

Objective: The aim of this study was to examine the relationship between stress and various socio-demographic, health and behavioural factors among undergraduate students studying in an Australian university. Methods: A cross-sectional survey was carried out among firstyear undergraduate students studying at Griffith University. Participants were recruited from four different academic groups (N=728). The questionnaire used in this study comprised of three sections: socio-demographic information, stress scale and a food frequency questionnaire. K-means Cluster analysis was performed to identify the major dietary patterns and multinomial logistic regression analysis was used to examine the factors associated with stress. Results: Nearly 53% of the students had some degree of stress with 37.4% experiencing moderate to severe levels of stress. The factors most strongly associated with having mild or moderate/ severe stress levels included being in a relationship [OR =1.71, 95% CI (1.02-2.87) and OR=1.61, 95% CI (1.06-2.44)], studying a non-health related degree [OR=1.68, 95% CI (1.03-2.73) and OR=1.51, 95% CI (1.04-2.19)], working ≥ 21 hours per week [OR=2.12, 95% CI (1.02-4.40) and OR=2.21, 95% CI (1.32-3.67)], and engaging in an unhealthy dietary pattern [OR=2.67, 95% CI (1.25-5.72) and OR=2.76, 95% CI (1.47-5.16)]. Being a female [OR=1.84, 95% CI (1.25-2.72)], living in a shared accommodation [OR=0.52, 95% CI (0.27-0.98)], rarely exercising [OR=2.64, 95% CI (1.59-4.39)], having a body mass index (BMI) of 25 or over [OR=2.03, 95% CI (1.36-3.04)], and engaging in a dietary pattern that was low in protein, fruit and vegetables [OR=1.72, 95% CI (1.06-2.77)] were also associated with having moderate/severe stress levels. Conclusion: This study found that more than half of the undergraduate students had some levels of stress. Both mild and moderate/severe levels of stress were associated with sociodemographic characteristics, risky health behaviours and poor dietary patterns. Our findings reinforce the need to promote healthy behaviours among undergraduate university students in order to maintain good mental health.</p

Depression, anxiety and risk of hypertension in mid-aged women::a prospective longitudinal study

The evidence for an association between depression and anxiety and increased hypertension risk is inconsistent. We aimed to investigate the association between each of depression and anxiety and incident hypertension

Factors Associated with Stress among First-year Undergraduate Students Attending an Australian University

Objective: The aim of this study was to examine the relationship between stress and various socio-demographic, health and behavioural factors among undergraduate students studying in an Australian university. Methods: A cross-sectional survey was carried out among first-year undergraduate students studying at Griffith University. Participants were recruited from four different academic groups (N=728). The questionnaire used in this study comprised of three sections: socio-demographic information, stress scale and a food frequency questionnaire. K-means Cluster analysis was performed to identify the major dietary patterns and multinomial logistic regression analysis was used to examine the factors associated with stress. Results: Nearly 53% of the students had some degree of stress with 37.4% experiencing moderate to severe levels of stress. The factors most strongly associated with having mild or moderate/ severe stress levels included being in a relationship [OR =1.71, 95% CI (1.02-2.87) and OR=1.61, 95% CI (1.06-2.44)], studying a non-health related degree [OR=1.68, 95% CI (1.03-2.73) and OR=1.51, 95% CI (1.04-2.19)], working ≥ 21 hours per week [OR=2.12, 95% CI (1.02-4.40) and OR=2.21, 95% CI (1.32- 3.67)], and engaging in an unhealthy dietary pattern [OR=2.67, 95% CI (1.25-5.72) and OR=2.76, 95% CI (1.47-5.16)]. Being a female [OR=1.84, 95% CI (1.25-2.72)], living in a shared accommodation [OR=0.52, 95% CI (0.27-0.98)], rarely exercising [OR=2.64, 95% CI (1.59-4.39)], having a body mass index (BMI) of 25 or over [OR=2.03, 95% CI (1.36-3.04)], and engaging in a dietary pattern that was low in protein, fruit and vegetables [OR=1.72, 95% CI (1.06-2.77)] were also associated with having moderate/severe stress levels. Conclusion: This study found that more than half of the undergraduate students had some levels of stress. Both mild and moderate/severe levels of stress were associated with sociodemographic characteristics, risky health behaviours and poor dietary patterns. Our findings reinforce the need to promote healthy behaviours among undergraduate university students in order to maintain good mental health

Including Information on Overdiagnosis in Shared Decision Making : A Review of Prostate Cancer Screening Decision Aids

Publisher Copyright: © The Author(s) 2022.Background. Overdiagnosis is an accepted harm of cancer screening, but studies of prostate cancer screening decision aids have not examined provision of information important in communicating the risk of overdiagnosis, including overdiagnosis frequency, competing mortality risk, and the high prevalence of indolent cancers in the population. Methods. We undertook a comprehensive review of all publicly available decision aids for prostate cancer screening, published in (or translated to) the English language, without date restrictions. We included all decision aids from a recent systematic review and screened excluded studies to identify further relevant decision aids. We used a Google search to identify further decision aids not published in peer reviewed medical literature. Two reviewers independently screened the decision aids and extracted information on communication of overdiagnosis. Disagreements were resolved through discussion or by consulting a third author. Results. Forty-one decision aids were included out of the 80 records identified through the search. Most decision aids (n = 32, 79%) did not use the term overdiagnosis but included a description of it (n = 38, 92%). Few (n = 7, 17%) reported the frequency of overdiagnosis. Little more than half presented the benefits of prostate cancer screening before the harms (n = 22, 54%) and only 16, (39%) presented information on competing risks of mortality. Only 2 (n = 2, 5%) reported the prevalence of undiagnosed prostate cancer in the general population. Conclusion. Most patient decision aids for prostate cancer screening lacked important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis in decision aids, including appropriate content, terminology and graphical display. Most patient decision aids for prostate cancer screening lacks important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis.Peer reviewe

Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review

OBJECTIVE: Overdiagnosis and overuse of healthcare services harm individuals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any review of relevant evidence, we conducted a scoping review of the evidence around overdiagnosis and overuse of diagnostic and screening tests in LMICs. DESIGN: Scoping review. METHODS: We searched PubMed, Embase, PsycINFO, Global Index Medicus for relevant studies published until 24 May 2021, with no restrictions on date or language. We categorised included studies by major focus (overdiagnosis, overuse of tests, or both) and main themes (presence or estimates of extent; drivers; consequences and solutions). RESULTS: We identified 2763 unique records and included 162 articles reporting on 154 studies across 55 countries, involving over 2.8 million participants and/or requests for tests. Almost half the studies focused on overdiagnosis (70; 45.5%), one-third on overuse of tests (61; 39.6%) and one-fifth on both (23; 14.9%). Common overdiagnosed conditions included malaria (61; 39.6%) and thyroid cancer (25; 16.2%), estimated to be >70% in China. Overused tests included imaging (n=25 studies) such as CT and MRI; laboratory investigations (n=18) such as serological tests and tumour markers; and procedures (n=14) such as colonoscopy. Drivers included fear of conflict with patients and expanding disease definitions. Common consequences included unnecessary treatments such as antimalarials, and wasted resources, with costs of malaria overdiagnosis estimated at US$86 million in Sudan in 1 year alone. Only 9% of studies discussed solutions, which included addressing inappropriately lowered diagnostic thresholds and reforming test-ordering processes. CONCLUSIONS: Overdiagnosis and overuse of tests are widespread in LMICs and generate significant harm and waste. Better understanding of the problems and robust evaluation of solutions is needed, informed by a new global alliance of researchers and policy-makers