An algorithm for augmenting cancer registry data for epidemiological research applied to oesophageal cancers

Oesophageal cancer is an important cancer with short survival, but the relationship between pre-diagnosis health behaviour and post-diagnosis survival remains poorly understood. Cancer registries can provide a high quality census of cancer cases but do not record pre-diagnosis exposures. The aim of this thesis is to document relationships between pre-diagnosis health behaviours on post-diagnosis survival times in oesophageal cancer, developing new methods as required. A systematic review and meta-analysis conducted in 2014, and updated in 2021, to investigate the association between pre-diagnosis health behaviours and oesophageal cancer. Visualising health behaviour variables as part of the cancer registry data set, with 100% missing data, led to the development of new approaches for augmenting US oesophageal cancer registry data with health behaviour data from a US national health survey Firstly, the health survey data were used to create logistic regression models of the probability of each behaviour relative to demographic characteristics and then these models were applied to cancer cases to estimate their probability of each behaviour. Secondly, cold-deck imputation such that two randomly selected but demographically similar health survey respondents both donated their health behaviour to the matching cancer case. The agreement between these two imputed values was used as an estimate of the misclassification and corrected for during the analyses. The logistic regression imputation-based analyses returned accurate point estimates, with wide confidence intervals, if the behaviour occurred in more than approximately 5% of cases. Our reviews and analyses confirmed that pre-diagnosis smoking decreased survival in oesophageal cancer (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.00-1.17) particularly squamous cell carcinoma when comparing highest to lowest lifetime exposure ( and HR 1.55, 95%CI 1.25-1.94); with similar associations for alcohol consumption. Pre-diagnosis leisure time physical activity was found to be associated with reduced hazard (HR 0.25, 95%CI 0.03,0.81) overall. Findings from these analyses can assist in modelling the impact of current changes in community health behaviour, as well as informing prognosis and treatment decisions at the individual level. This novel method of augmenting cancer registry data with pre-diagnosis variables appears to be effective and will benefit from further validation. This thesis has significantly progressed both issues and identified future opportunities for research and development

Key issues in rural health: perspectives of health service providers in Queensland

The Centre for Rural and Remote Area Health (CRRAH) held interactive research workshops in eight towns in Southern Queensland. The purpose of the workshops was to determine what health providers considered were major issues affecting their service and for these results to inform future research strategy of CRRAH. Over 150 organisations identified as either providing health services or having a significant interest in health provision in one or more of the targeted towns were invited to attend. The workshops used the nominal group technique to identify what the participants considered were key health issues in the geographical area in which they worked. These issues were then prioritised by the participants. Thematic analysis of the issues generated a ranking of themes by importance. Results were compared with a similar exercise undertaken in 2003. Participants from organisation directly involved with health care were complemented at the workshops by representatives from local government, the police service and church groups. A total of 85 participants representing 47 services and 41 different organisations attended the eight workshops. Issues generated by the participants were pooled into seventeen themes. Workforce issues were by far the major concern of health providers. Recruitment and retention of health workers were a major concern. The other four highest ranked themes across all workshops were mental health, access to health services, perceptions and expectations of consumers of health services and interagency cooperation. Aged care was an additional theme that generated a lot of concern at several of the workshops. The workshops provided important information to CRRAH for developing research strategy. Additionally, several new alliances among health providers were developed which will support sharing of information and resources. The workshops enabled rural and remote organisations to meet and identify the key health issues and supported research planning. Much need alliances among health providers were forged and collaborative research avenues are being explored. The workshop forum is an excellent means of information exchange

A randomised clinical trial comparing outcomes of a single digit volar plate injury : buddy loops versus dorsal thermoplastic orthosis in a neutral position : study protocol

Background Volar plate injuries are a common hand injury and complications associated with this injury such as a fixed flexion deformity, persistent pain and oedema can have a significant impact on a person’s function. The literature reports these injuries are treated using various splinting materials such as thermoplastic, in varying degrees of proximal interphalangeal joint flexion or buddy loops. Despite volar plate injuries being reported as common, optimal non-surgical treatment of these injuries remains unclear. This study aims to investigate whether a dorsal blocking orthosis in a neutral position (00) is more effective than buddy loops for a volar plate injury to the proximal interphalangeal joint in preventing a fixed flexion deformity, reducing pain, managing oedema, and promoting function. Methods This study is a single-centre, prospective parallel-group, single blinded (assessor), randomised clinical trial. Patients between 18–65 years, who have sustained a volar plate injury to a single digit, have adequate cognitive functioning and give written informed consent will be invited to participate in this study. Patients will be randomised to either the control group where they will be fitted with buddy loops and commence early active motion exercises or the experimental group where they will receive a dorsal thermoplastic orthosis in a neutral position and commence early active motion exercises. The primary outcome measure is passive proximal interphalangeal joint extension and secondary outcome measures include passive range of motion, total passive motion, active range of motion, total active motion, grip strength, oedema, pain, function and adherence to treatment. Assessments will be completed until 8 weeks following commencement of treatment. The sample size calculation indicates that 23 patients is required in each group. With an expected dropout rate of 25% a total of 32 patients will be enrolled in each group. Discussion This study will assist in trying to improve treatment of volar plate injuries and assist in reducing complications associated with volar plate injuries, potentially reducing the need for prolonged hand therapy. Trial registration This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001425785p). Ethical approval has been granted by the South Eastern Sydney Local Health District ethical committee (2022/ETH01697)

A suggested sampling algorithm for use with ATP testing in cleanliness measurement

Introduction: Rapid Adenosine Triphosphate (ATP) testing is becoming a commonly used method to measure cleanliness on reusable medical devices and healthcare environmental surfaces. Unfortunately, ATP testing devices suffer from inherent variability from a number of sources including imprecision in ATP measurement. Method: This paper proposes a new sampling algorithm which reduces the impact of inherent variability and thus improves decision making when using ATP testing. Conclusion: This algorithm can be applied across a variety of applications to provide more reliable data on measurable cleanliness standards for both medical devices and environmental surfaces. Formal trials using the new ATP sampling algorithm are required

Using a simplified ATP algorithm to improve data reliability and improve cleanliness standards for surface and medical device hygiene

Background: An algorithm has been improved to mitigate variability in cleanliness measurements of various surfaces using rapid Adenosine Triphosphate (ATP) testing. A cleaning intervention step (CIS) verifies the cleanability of those surfaces. Methods: ATP testing was performed on surfaces which were pre-approved as “clean” and ready for re-use. Adjacent (duplicate) ATP sampling was undertaken on 421 environmental surfaces, medical devices and other implements. The CIS was conducted on 270 surfaces using an aseptic technique and disposable cleaning wipes. Results: The two initial ATP results were plotted against each other with a 100 RLU threshold grading the results as clean (2x 100RLU) or equivocal (1x 100RLU). Of the surfaces sampled, 68.5 % were clean (288/421), 13.5 % were dirty (57/421) and 18 % were equivocal (76/421). The duplicate testing demonstrated a false negative rate of 10 % (44/421) where the first swab was 100 RLU. For the equivocal group, the gap between the two swabs was >100 RLU for 7.5 % of surfaces (33/421). The CIS was conducted on 270 of the surfaces tested and showed that cleaning could be improved (P=<0.001) on 88.5 % of surfaces (239/270). Conclusion: The simplified ATP testing algorithm provides real-time discrimination between surface cleanliness levels and improved certainty over surface hygiene. The duplicate swab sampling approach mitigates uncontrolled variability in the results and the CIS provides a nuanced understanding of the measurable cleanliness of any surface

The efficacy of imagery in the rehabilitation of people with Parkinson's disease : protocol for a systematic review and meta-analysis

Background: Parkinson’s disease (PD) is a neurodegenerative disorder of the nervous system that affects movement. Individuals with PD commonly experience difficulty initiating movements, slowness of movements, decreased balance, and decreased standing ability. It has been shown that these motor symptoms adversely affect the independence of individuals with PD. Imagery is the cognitive process whereby a motor action is internally reproduced and repeated without overt physical movement. Recent studies support the use of imagery in improving rehabilitation outcomes in the PD population. However, these data have inconsistencies and have not yet been synthesised. The study will review the evidence on the use of imagery in individuals with PD and to determine its efficacy in improving rehabilitation outcomes. Methods: Randomised controlled clinical trials comparing the effects of imagery and control on activities, body structure and function, and participation outcomes for people with PD will be included. A detailed computer-aided search of the literature will be performed from inception to June 2021 in the following databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science, and Scopus. Two independent reviewers will screen articles for relevance and methodological validity. The Physiotherapy Evidence Database (PEDro) scale will be utilised to evaluate the risk of bias of selected studies. Data from included studies will be extracted by two independent reviewers through a customised, pre-set data extraction sheet. Studies using imagery with comparable outcome measures will be pooled for meta-analysis using the random effect model with 95% CI. If individual studies are heterogeneous, a descriptive review will analyse variance in interventions and outcomes. A narrative data analysis will be considered where there is insufficient data to perform a meta-analysis. Discussion: Several studies investigating imagery in the PD population have drawn dissimilar conclusions regarding its effectiveness in rehabilitation outcomes and clinical applicability. Therefore, this systematic review will gather and critically appraise all relevant data, to generate a conclusion and recommendations to guide both clinical practice and future research on using imagery in the rehabilitation of people with PD. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Unhealthy diet pattern mediates the disproportionate prevalence of obesity among adults with socio-economic disadvantage : an Australian representative cross-sectional study

The role of unhealthy dietary pattern in the association between socio-economic factors and obesity is unclear. The aim was to examine the association between socio-economic disadvantage and obesity and to assess mediation effect of unhealthy dietary pattern defined using the Mediterranean diet criteria. The data source was the Australian National Nutrition and Physical Activity Survey. The study sample included 7744 participants aged 18 years and over, 28% of whom had obesity. We used the Australian Socio-Economic Indexes for Areas (SEIFA) classification system for categorizing socio-economic disadvantage; calculated the Mediterranean Diet Score (MDS) using standard criteria; and used measured body mass index to define obesity. We conducted a mediation analysis using log–binomial models to generate the prevalence ratio for obesity and the proportion mediated by the MDS. The most disadvantaged group was associated with higher level of obesity after controlling for covariates (1.40, 95% CI 1.25, 1.56) compared to the least disadvantaged group, and in a dose–response way for each decreasing SEIFA quintile. The relationship between socio-economic disadvantage and obesity was mediated by the MDS (4.0%, 95% CI 1.9, 8.0). Public health interventions should promote healthy dietary patterns, such as the Mediterranean diet, to reduce obesity, especially in communities with high socio-economic disadvantage

Micronutrient deficiencies and anaemia associated with body mass index in Australian adults : a cross-sectional study

Aim To estimate the prevalence of micronutrient deficiencies and anaemia, and their association with body mass index (BMI) categories among Australian adults. Method We analysed data from the 2011–2013 Australian Health Survey from 3539 participants aged 18 years and over (without known pregnancy) with measured weight and height, and nutrient biomarkers. To address complex sampling, survey weights were used when estimating the prevalence of micronutrient deficiencies (vitamin B12 deficiency; serum vitamin B12<145 pmol/L; iron deficiency; ferritin<30 µg/L and vitamin D deficiency; 25-hydroxyvitamin D<50 nmol/L) and anaemia (haemoglobin <120 g/L for females and <130 g/L for males) and when assessing associations with logistic regression models with adjusted ORs (AORs) for BMI categories: healthy weight (BMI 18.5 to <25.0 kg/m2 ), reference; overweight (BMI 25.0 to <30.0 kg/m2 ), obesity class I (BMI 30.0 to <35.0 kg/m2 ), obesity class II/III (BMI 35.0 kg/m2 or more). Result The prevalence of vitamin B12 deficiency (range 0.9%─2.8%) and anaemia (range 3.9%─6.7%) were variable across BMI groups. The prevalence of iron deficiency in the obesity class I group was 12.0 percentage points lower than healthy weight group with an AOR of 0.50 (95% CI 0.30 to 0.83). The prevalence of vitamin D deficiency in the obesity class II/III group was 7.9 percentage points higher than the healthy weight group with an AOR of 1.62 (95% CI 1.01 to 2.60). Vitamin B12 deficiency and anaemia were not consistently associated with BMI groups. Conclusion We found a consistent association between severe obesity and vitamin D deficiency in Australian adults. We also found obesity class I was negatively associated with iron deficiency, whereas there was no consistent association between BMI groups and vitamin B12 deficiency and anaemia. Public health strategies are needed to prevent vitamin D deficiency in this high-risk population

A predictive model for non-completion of an intensive specialist obesity service in a public hospital : a case-control study

Background: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). Method: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. Results: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p &lt; 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). Conclusions: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services

Augmenting cancer registry data with health survey data with no cases in common : the relationship between pre-diagnosis health behaviour and post-diagnosis survival in oesophageal cancer

Background: For epidemiological research, cancer registry datasets often need to be augmented with additional data. Data linkage is not feasible when there are no cases in common between data sets. We present a novel approach to augmenting cancer registry data by imputing pre-diagnosis health behaviour and estimating its relationship with post-diagnosis survival time. Methods: Six measures of pre-diagnosis health behaviours (focussing on tobacco smoking, ‘at risk’ alcohol consumption, overweight and exercise) were imputed for 28,000 cancer registry data records of US oesophageal cancers using cold deck imputation from an unrelated health behaviour dataset. Each data point was imputed twice. This calibration allowed us to estimate the misclassification rate. We applied statistical correction for the misclassification to estimate the relative risk of dying within 1 year of diagnosis for each of the imputed behaviour variables. Subgroup analyses were conducted for adenocarcinoma and squamous cell carcinoma separately. Results: Simulated survival data confirmed that accurate estimates of true relative risks could be retrieved for health behaviours with greater than 5% prevalence, although confidence intervals were wide. Applied to real datasets, the estimated relative risks were largely consistent with current knowledge. For example, tobacco smoking status 5 years prior to diagnosis was associated with an increased age-adjusted risk of all cause death within 1 year of diagnosis for oesophageal squamous cell carcinoma (RR = 1.99 95% CI 1.24,3.12) but not oesophageal adenocarcinoma RR = 1.61, 95% CI 0.79,2.57). Conclusions: We have demonstrated a novel imputation-based algorithm for augmenting cancer registry data for epidemiological research which can be used when there are no cases in common between data sets. The algorithm allows investigation of research questions which could not be addressed through direct data linkage