An RCT of a decision aid to support informed choices about taking aspirin to prevent colorectal cancer and other chronic diseases: a study protocol for the SITA (Should I Take Aspirin?) trial.

BACKGROUND: Australian guidelines recommend that all people aged 50-70 years old actively consider taking daily low-dose aspirin (100-300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical practice. We aim to test the efficacy of a health consultation and decision aid, using a novel expected frequency tree (EFT) to present the benefits and harms of low dose aspirin prior to a general practice consultation with patients aged 50-70 years, on informed decision-making and uptake of aspirin. METHODS: Approximately five to seven general practices in Victoria, Australia, will be recruited to participate. Patients 50-70 years old, attending an appointment with their general practitioner (GP) for any reason, will be invited to participate in the trial. Two hundred fifty-eight eligible participants will be randomly allocated 1:1 to intervention or active control arms using a computer-generated allocation sequence stratified by general practice, sex, and mode of trial delivery (face-to-face or teletrial). There are two co-primary outcomes: informed decision-making at 1-month post randomisation, measured by the Multi-dimensional Measure of Informed Choice (MMIC), and self-reported daily use of aspirin at 6 months. Secondary outcomes include decisional conflict at 1-month and other behavioural changes to reduce CRC risk at both time points. DISCUSSION: This trial will test the efficacy of novel methods for implementing national guidelines to support informed decision-making about taking aspirin in 50-70-year-olds to reduce the risk of CRC and other chronic diseases. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001003965 . Registered on 10 October 2020

Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine.

Adequate clinical and parasitologic cure by artemisinin combination therapies relies on the artemisinin component and the partner drug. Polymorphisms in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes are associated with decreased sensitivity to amodiaquine and lumefantrine, but effects of these polymorphisms on therapeutic responses to artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) have not been clearly defined. Individual patient data from 31 clinical trials were harmonized and pooled by using standardized methods from the WorldWide Antimalarial Resistance Network. Data for more than 7,000 patients were analyzed to assess relationships between parasite polymorphisms in pfcrt and pfmdr1 and clinically relevant outcomes after treatment with AL or ASAQ. Presence of the pfmdr1 gene N86 (adjusted hazards ratio = 4.74, 95% confidence interval = 2.29 - 9.78, P < 0.001) and increased pfmdr1 copy number (adjusted hazards ratio = 6.52, 95% confidence interval = 2.36-17.97, P < 0.001 : were significant independent risk factors for recrudescence in patients treated with AL. AL and ASAQ exerted opposing selective effects on single-nucleotide polymorphisms in pfcrt and pfmdr1. Monitoring selection and responding to emerging signs of drug resistance are critical tools for preserving efficacy of artemisinin combination therapies; determination of the prevalence of at least pfcrt K76T and pfmdr1 N86Y should now be routine

Findings in young adults at colonoscopy from a hospital service database audit

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Colorectal cancer (CRC) diagnosed at <50 years is predominantly located in the distal colon and rectum. Little is known about which lesion subtypes may serve as CRC precursors in young adults. The aim of this work was to document the prevalence and histological subtype of lesions seen in patients aged <50 years, and any associated clinical features. Methods An audit of the colonoscopy database at The Queen Elizabeth Hospital in Adelaide, South Australia over a 12-month period was undertaken. Findings were recorded from both colonoscopy reports and corresponding histological examination of excised lesions. Results Data were extracted from colonoscopies in 2064 patients. Those aged <50 comprised 485 (24%) of the total. CRC precursor lesions (including sessile serrated adenoma/polyps (SSA/P), traditional serrated adenomas, tubular adenomas ≥10 mm or with high-grade dysplasia, and conventional adenomas with villous histology) were seen in 4.3% of patients aged <50 and 12.9% of patients aged ≥50 (P <0.001). Among colonoscopies yielding CRC precursor lesions in patients under 50 years, SSA/P occurred in 52% of procedures (11/21), compared with 27% (55/204) of procedures in patients aged 50 and older (P = 0.02). SSA/P were proximally located in (10/11) 90% of patients aged under 50, and 80% (43/54) of those aged 50 and older (P = 0.46). Conclusions SSA/P were the most frequently observed CRC precursor lesions in patients aged <50. Most CRCs in this age group are known to arise in the distal colon and rectum suggesting that lesions other than SSA/P may serve as the precursor for the majority of early-onset CRC

The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study

Background: Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup differences. Methods: We pooled data from seven prospective Australian cohort studies (n ¼ 367 058) and linked them to national registries to identify CRCs and deaths. We estimated the strength of the associations between behaviors and CRC risk using a parametric piecewise constant hazards model, adjusting for age, sex, study, and other behaviors. Exposure prevalence was estimated from contemporary National Health Surveys. We calculated population attributable fractions for CRC preventable by changes to current behaviors, accounting for competing risk of death and risk factor interdependence. Statistical tests were two-sided. Results: During the first 10 years of follow-up, there were 3471 incident CRCs. Overweight or obesity explained 11.1%, ever smoking explained 10.7% (current smoking 3.9%), and drinking more than two compared with two or fewer alcoholic drinks per day explained 5.8% of the CRC burden. Jointly, these factors were responsible for 24.9% (95% confidence interval [CI] ¼ 19.7% to 29.9%) of the burden, higher for men (36.7%) than women (13.2%, Pdifference < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, Pdifference ¼ .047). We observed modification of the smoking-attributable burden by alcohol consumption and educational attainment, and modification of the obesity-attributable burden by age group and birthplace. Conclusions: We produced up-to-date estimates of the future CRC burden attributed to modifiable behaviors. We revealed novel differences between men and women, and other high–CRC burden subgroups that could potentially benefit most from programs that support behavioral change and early detection.This work was supported by the Australian National Health and Medical Research Council (NHMRC; ID1060991). The Australian NHMRC also supported Dr. Laaksonen (ID1053642), Prof. Canfell (ID1082989), Prof. Banks (ID1042717), Prof. Shaw (ID1079438), and Prof. Magliano (ID1118161). Dr. Laaksonen was additionally supported by the Cancer Institute of New South Wales (ID13/ECF/1-07). Ms. Arriaga was supported by an Australian Postgraduate Award and a Translational Cancer Research Network PhD Scholarship Top-up Award

A Large Linked Study to Evaluate the Future Burden of Cancer in Australia Attributable to Current Modifiable Behaviours

Introduction The cancer burden preventable through modifications to risk factors can be quantified by calculating their population attributable fractions (PAFs). PAF estimates require large, prospective data to inform risk estimates and contemporary population-based prevalence data to inform the current exposure distributions, including among population subgroups. Objectives and Approach We provide estimates of the preventable future cancer burden in Australia using large linked datasets. We pooled data from seven Australian cohort studies (N=367,058) and linked them to national registries to identify cancers and deaths. We estimated the strength of the associations between behaviours and cancer risk using a proportional hazards model, adjusting for age, sex, study and other behaviours. Exposure prevalence was estimated from contemporary National Health Surveys. We harmonised risk factor data across the data sources, and calculated PAFs and their 95% confidence intervals using a novel method accounting for competing risk of death and risk factor interdependence. Results During the first 10-years follow-up, there were 3,471 incident colorectal cancers, 640 premenopausal and 2,632 postmenopausal breast cancers, 2,025 lung cancers and 22,078 deaths. The leading preventable causes were current smoking (53.7% of lung cancers), body fatness or BMI ≥ 25kg/m2 (11.1% of colorectal cancers, 10.9% of postmenopausal breast cancers), and regular alcohol consumption (12.2% of premenopausal breast cancers). Three in five lung cancers, but only one in four colorectal cancers and one in five breast cancers, were attributable to modifiable factors, when we also considered physical inactivity, dietary and hormonal factors. The burden attributable to modifiable factors was markedly higher in certain population subgroups, including men (colorectal, lung), people with risk factor clustering (colorectal, breast, lung), and individuals with low educational attainment (breast, lung). Conclusion/Implications Estimating PAFs for modifiable risk factors across cancers using contemporary exposure prevalence data can inform timely public health action to improve health and health equity. Testing PAF effect modification may identify population subgroups with the most to gain from programs that support behaviour change and early detection

Raising the awareness of undergraduate nurses to the psychosocial impact of living with cancer: A consumer engagement in teaching initiative

This article reflects on the development and implementation of a consumer engagement in teaching initiative by the authors. The authors highlight the challenges of engaging undergraduate nursing students on the psychosocial aspects of living with cancer and other chronic illnesses when students have very limited personal and professional experiences to draw on. The authors discuss how they have responded to these challenges by integrating the voices of consumers into their classrooms. Speakers from consumer advocacy organization, Cancer Voices SA, participated in a series of tutorials in a 1 st year topic in the Undergraduate Nursing Program at the School of Nursing and Midwifery, Flinders University. Student feedback from the implementation of the initiative indicated that students found consumers′ stories and experiences of living with cancer, "moving and powerful" and that they encouraged students to question their assumptions about the psychosocial impacts of cancer on individuals and families. The importance of good communication in reducing patient distress was identified by students as an important element of consumers′ experiences of the health care system as was the need for transparency and information sharing between health care providers across the health care system. For many students, consumers′ stories and experiences had reinforced students′ commitment to studying nursing and pursuing a career in nursing. The article concludes that involving consumers in the education of health care professionals encourages a much deeper understanding of and empathy for how patients experience disease, which is integral to the provision of patient-centered and holistic care

Predictors of depression 12 months after cardiac hospitalization: the identifying depression as a comorbid condition study

The definitive version is available at www.blackwell-synergy.comObjective: To determine characteristics which predict depression at 12 months after cardiac hospitalization, and track the natural history of depression. Method: Depressive symptoms were monitored at baseline, 3 and 12 months in a cohort of 785 patients, using the self-report Center for Epidemiological Studies Depression Scale. Multinomial regression analyses of baseline clinical and demographic variables identified characteristics associated with depression at 12 months. Results: Three baseline variables predicted moderate to severe depression at 12 months: depression during index admission, past history of emotional health problems and current smoking. For those who were depressed during cardiac hospitalization, 51% remained depressed at both 3 and 12 months. Persistence was more evident in patients who had moderate to severe depressive symptoms when hospitalized. Mild depression was as likely to persist as to remit. Conclusions: Three clinically accessible characteristics at the time of cardiac hospitalization can assist in predicting depression at 12 months and may aid treatment decisions. Depressive symptoms persist in a substantial proportion of cardiac patients up to 12 months after hospitalization. Key words: depression, heart disease, inpatient, natural history, predictor.Geoff Schrader, Frida Cheok, Ann-Louise Hordacre and Julie Marke

Identification, course, and treatment of depression after admission for a cardiac condition: rationale and patient characteristics for the identifying depression as a comorbid condition (IDACC) project.

Copyright © 2003 Mosby, Inc. All rights reserved.Background Given the prevalence of cardiovascular disease and the high rates of depression among cardiac patients, there is a need to develop practical ways to identify this population and provide pragmatic general-practitioner–based interventions for managing depression as a comorbid condition. Method The Identifying Depression As a Comorbid Condition (IDACC) study employed a hybrid design, incorporating a randomized controlled trial nested within a prospective cohort study. IDACC screened for depression in patients hospitalized in South Australia for a range of cardiac conditions, with outcome measures monitored for 12 months after discharge. The subgroup identified as depressed was entered into the nested IDACC trial, which tests the hypothesis that identifying depression and offering an evidence-based intervention to general practitioners, incorporating multidisciplinary telephone case conferencing, will reduce levels of depression, improve quality of life, and reduce associated economic costs. Results At baseline, 46.3% of 1455 participants screened were classified as depression cases on the basis of their score on the Center for Epidemiological Studies Depression Scale (≥16) or the Hospital Anxiety and Depression Scale (≥8). Elevated scores were associated with being younger, female, divorced or separated, not employed, living alone, having a lower level of education, and having poorer health and quality of life. Nearly one fifth (19.4%) of participants had Center for Epidemiological Studies Depression Scale scores >27, which is indicative of major depression. Conclusions This project confirms, in an Australian setting, the high prevalence of depressive symptoms among hospitalized cardiac patients. Follow-up over 12 months will enhance understanding of the natural history of depression in cardiac patients, while the nested trial will inform on effectiveness of an intervention involving tailored advice and support to general practitioners.Frida Cheok, Geoffrey Schrader, David Banham, Julie Marker and Ann-Louise Hordacrehttp://www.elsevier.com/wps/find/journaldescription.cws_home/623272/description#descriptio

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Single-center study comparing computed tomography colonography with conventional colonoscop