Search

Background: The aim of this work was to develop a National Evaluation Framework to facilitate the standardization of delivery, quality, reporting, and evaluation of diabetes education and support programs delivered throughout Australia through the National Diabetes Services Scheme (NDSS). The NDSS is funded by the Australian Government, and provides access to diabetes information, education, support, and subsidized product across diverse settings in each state and territory of Australia through seven independent service-providers. This article reports the approach undertaken to develop the Framework., Methods: A participatory approach was undertaken, focused on adopting nationally consistent outcomes and indicators, nominating objectives and measurement tools, specifying evaluation processes, and developing quality standards. Existing programs were classified based on related, overarching indicators enabling the adoption of a tiered system of evaluation., Results: Two outcomes (i.e., improved clinical, reduced cost) and four indicators (i.e., improved knowledge and understanding, self-management, self-determination, psychosocial adjustment) were adopted from the Eigenmann and Colagiuri national consensus position statement for diabetes education. This allowed for the identification of objectives (i.e., improved empowerment, reduced distress, autonomy supportive program delivery, consumer satisfaction) and related measurement instruments. Programs were categorized as comprehensive, topic-specific, or basic education, with comprehensive programs allocated to receive the highest-level of evaluation. Eight quality standards were developed, with existing programs tested against those standards. Based on the results of testing, two comprehensive (OzDAFNE for people with type 1 diabetes, DESMOND for people with type 2 diabetes), and eight topic-specific (CarbSmart, ShopSmart, MonitorSmart, FootSmart, MedSmart, Living with Insulin, Insulin Pump Workshop, Ready Set Go - Let's Move) structured diabetes self-management education and support programs were nominated for national delivery., Conclusions: The National Evaluation Framework has facilitated consistency of program quality, delivery, and evaluation of programs delivered by multiple service providers across diverse contexts. The Framework could be applied by other service providers who facilitate multiple diabetes education and support programs and could be adapted for use in other chronic disease populations where education and support are indicated., (© 2022. The Author(s).)

Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (P homogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences., (© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Objectives: The aim of this birth cohort study was to identify concurrent associations between early childhood caries and putative risk and protective factors., Methods: Data were collected in seven waves over five years. The study outcome measure, d 3-6 mfs, was modelled in a set of sequential negative binomial regressions that introduced the variables in steps starting from health determinants most distal to the child and ending with the more proximal ones. The goodness of fit of each model at each step was tested using the quasi-likelihood under independence model criterion (QIC). A final model included all significant factors identified in the sequential modelling. Bacterial composition of the child's saliva was determined by 16S RNA gene sequencing., Results: Overall, 467 children (48.6 % female) participated, of whom 419 (89.7 %) had at least one follow-up visit after baseline. Of the 419 children included in the analyses, 133 (31.7 %) had their saliva samples sequenced for microbiomic determination. Independent protectors of surface cavitation included water fluoridation, and older age of mothers. Risk for d 3-6 mfs was significantly higher among children whose mothers were current smokers (IRR 3.29, 95 % CI 1.09-9.88, p = 0.034), children who went to bed with a bottle (IRR 2.67, 95-6.88, p = 0.041) and whose saliva sample sequencing over time showed higher percentages of Streptococcus mutans (IRR 1.39, 95 % CI 1.11-1.74, p = 0.005). Model fit was mostly improved by child's proximal variables. Household and mother covariates did not substantially improve model fit., Conclusion: This analysis highlights the relevance and importance of child-proximal risk factors in childhood dental cavitation., Clinical Significance: The study findings inform clinical decision making for the management of early childhood caries at both the individual and population level. At an individual and family level these risk factors should be incorporated into caries risk assessment tools for more precise identification of risk and evidence-informed interventions by health professionals., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Dietary intakes of B vitamins and other components involved in one-carbon metabolism, which is necessary for DNA replication, DNA repair, and regulation of gene expression, may be associated with carcinogenesis. We investigated associations between intakes of 11 nutrients (thiamine, riboflavin, niacin, pantothenic acid, vitamin B6, biotin, folate, vitamin B12, methionine, choline, and betaine) and gastric cancer risk. A total of 159 incident gastric cancer cases were identified from the Melbourne Collaborative Cohort Study (N = 41,513) and matched with 159 controls on year of birth, sex, and country of birth using incidence density sampling. Dietary intakes of nutrients were estimated at baseline (1990-1994) using a 121-item food frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals were estimated using conditional logistic regression models adjusting for Helicobacter pylori infection, and other potential confounders. We observed a positive association between intake of niacin and overall gastric cancer risk (OR = 1.33, 95%CI: 1.01-1.75 per SD increment). For thiamine, heterogeneity by subtype (cardia and non-cardia) was found (P het  = 0.05), with weak evidence of an inverse association with cardia cancer risk. Our results do not support increasing intakes of B vitamins or other nutrients involved in one-carbon metabolism to reduce gastric cancer risk in a well-nourished population.

Helicobacter pylori infection is a major cause of morbidity and mortality worldwide. More than 50% of the global population is estimated to be infected. Differences in prevalence exist within and between countries, with higher prevalence seen among people with lower socio-economic status. Most transmission of infection occurs early in life, predominantly from person to person in the family setting. H. pylori is the cause of most peptic ulcer disease, gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma and causes symptoms in a subset of patients with functional dyspepsia. Choice of diagnostic test depends on the clinical context; urea breath tests and endoscopy with biopsy are the major diagnostic tools. Evidence-based indications for eradication of H. pylori infection are well documented. The most widely used and recommended eradication therapy in Australia is triple therapy comprising a proton pump inhibitor, amoxycillin and clarithromycin, usually for 1 week. Effective alternative regimens are available for patients with proven allergy to penicillin. Antimicrobial resistance is the major determinant of the outcome of eradication therapy. Trends in antibiotic resistance need to be monitored locally, but individual patient susceptibility testing is not usually necessary as it rarely guides the choice of therapy. The outcome of treatment should be assessed not less than 4 weeks after therapy. This is usually done with a urea breath test if follow-up endoscopy is not required. When first-line therapy fails, several proven second-line therapies may be used. Repeat first-line therapy and ad hoc regimens should be avoided. Overall cumulative eradication rates should approach 99%.

Social Café Meals Programs aim to reduce food insecurity and social exclusion by providing participants access to subsidised meals in mainstream local cafés. This study aimed to explore the program's ability to address social exclusion and food insecurity and the impact of the program on the community. A qualitative evaluation approach was utilised whereby in-depth interviews were conducted with café owners, café staff and current program members of two Social Café Meals Programs operating in the south-eastern suburbs of Melbourne. Twelve program members and six café staff completed an in-depth interview at the local cafés. Data were analysed using a thematic analysis approach focusing on the lived experience of the café owners, staff and program members. Four key themes were identified. The program (i) improved food access for vulnerable groups and (ii) created community cohesiveness. (iii) The café environment was important in facilitating program use by community members. (iv) Café owners felt rewarded for their community contribution via the program. Social Café Meals Programs may provide a solution to improving food security and reducing social exclusion and may be considered as a strategy for improving nutrition and social health for at-risk and vulnerable groups.

The presence of Helicobacter species in Australian marsupials was examined systematically using microscopy, culture, and PCR in different regions of the gastrointestinal tract (GIT) and in the liver of brushtail possums (BTPs) (Trichosurus vulpecula), a common Australian marsupial that feeds on eucalyptus leaves. The spatial distribution of Helicobacter species in the GIT sections also was examined microscopically in silver-stained sections and by fluorescent in situ hybridization (FISH) using a Helicobacter genus-specific probe. Helicobacter species were found colonizing the lower bowel of all BTPs studied. Good agreement was observed between the detection of Helicobacter species using culture and PCR, which was supported by the microscopic examination of silver-stained sections and FISH. The lower bowel of BTPs were colonized by one to three morphologically different (a comma-shaped species with no apparent flagella, a fusiform-shaped species entwined with periplasmic fibers and a bipolar sheathed flagella, and an S-shaped species with bipolar sheathed flagella) and potentially novel Helicobacter species, as well as in one case with a potentially novel Campylobacter species, which was a tightly coiled rod with bipolar unsheathed flagella. The isolation and characterization of these Helicobacter species in BTPs provides important information regarding the specific natural niche of these bacteria and their corelationship within their host, and it increases our understanding of the ecology of Helicobacter species.

Australia utilises nationally approved guidelines for managing women with abnormal Pap smears. The guidelines were recently revised using the process designated by the National Health and Medical Research Council. Revising the guidelines was protracted and controversial. This paper explores the reasons for the difficulties encountered and queries the cost of undertaking such work.

Background: The current study was undertaken to assist with providing an evidence-based approach to the management of women with cervical cytology reports of low-grade squamous abnormality as used in the Australian organized screening program., Methods: Using the Pap Test Registers, an audit was performed of the outcome over 24 months of Australian women who received an index cervical cytology report of low-grade squamous abnormality in 1999., Results: Information was available for 76,709 of the 90,566 women whose first cytology report in 1999 was of a low-grade squamous abnormality. Forty-one cases of histologically confirmed cervical carcinoma were diagnosed during the subsequent 24 months (10 Stage IA, 31 Stage IB or worse). Five of the 10 women who were diagnosed with Stage IA carcinoma during the 24 months of follow-up had an intervening cervical biopsy of high-grade intraepithelial abnormality. The risk of cervical carcinoma diagnosis during the 24 months was 0.05% (95% confidence interval [CI], 0.03-0.07%) for the women with nonspecific minor change index cytology, 0.03% (95% CI, 0.00-0.07%) for the women with human papillomavirus index cytology, and 0.07% (95% CI, 0.03-0.11%) for the women with Grade 1 cervical intraepithelial neoplasia index cytology., Conclusions: Cervical carcinoma was a very rare outcome within 2 years of a cytology report of low-grade squamous abnormality in Australia. A simplified terminology for low-grade squamous cervical cytology reports should be considered by Australia, with uniform management for asymptomatic women., (Copyright (c) 2005 American Cancer Society.)

Application of nested PCR for Helicobacter species to 416 samples obtained at colonoscopy from 15 patients with Crohn's disease, 12 with ulcerative colitis, and 43 controls revealed H. pylori DNA in only 6 individuals with no disease association. No other Helicobacter species were detected in ileal or colonic samples.

Objective: To report the interval cancer rate for BreastScreen Victoria., Design: Electronic linkage of Breast Screen Victoria records with those of the Victorian Cancer Registry. Interval cancers were expressed as a proportion of the underlying incidence (proportional incidence), and the sensitivity as the number of screen detected invasive breast cancers divided by the total number of invasive breast cancers diagnosed in the screening interval., Setting: Victoria, Australia where biennial screening is provided to women aged 40 and older., Subjects: Victorian women aged 40-79 who attended first round screening in 1994 (103,023 women) and 1995 (107,057 women)., Results: The sensitivity of screening mammography for the two year interval increased with age (p for trend < 0.001) and was 49.4% in women aged 40-49, 68.6% in 50-59 year old women, 80.7% in 60-69 year old women, and 85.2% in women aged 70-79. The proportional incidence in the first year after screening was 59% in 40-49 year old women and 27% in women aged 50-69. In the second year the proportional incidence was 93% in 40-49 year old women and 54% in women aged 50-69., Conclusions: Interval cancers comprise such a large proportion of the expected number of cancers in 40-49 year old women that the benefit of screening is likely to be low. For women aged 50-69, the proportional incidence found in this study was similar to those found in the UK programmes.

The cervical cancer screening program in Australia has an emerging litigation problem. This paper reviews some recent initiatives taken to address the problem. These initiatives include the establishment of registries of women being screened, education to promote an appreciation of the limitations of screening, and the introduction of outcome standards for laboratories reporting cervical cytology. An international evidence-based definition of the standard of care is the most pressing need in the immediate future. Possible roles of report disclaimers, informed consent, improved information about the average level of accuracy of a cervical cytology report, and the use of a range of differential diagnoses in addressing the medicolegal problems of cervical screening are explored.

OBJECTIVES - To describe age specific frequencies of Pap smear and colposcopy use in the Australian Capital Territory (ACT) and to estimate the cumulative effects of current patterns of use. SETTING - Frequencies of Pap smear and colposcopy use were estimated for the financial year from 1 July 1989 to 30 June 1990. Eligible women were between the ages of 15 and 74, living in the ACT. METHODS - Data collected from a 10% sample of subjects enrolled with Medicare and from the only public pathology laboratory in the ACT were used to estimate age specific frequencies. The expected number of deaths from cervical cancer in the ACT in the absence of a screening programme was estimated by applying Australian age specific mortality rates for cervical cancer between 1960 and 1964 to the 1989 ACT population. A life table approach was used to simulate the cumulative risk of colposcopy - given current age specific rates - on a hypothetical cohort of 1000, 15 year old women. RESULTS - Forty four per cent (95% confidence interval (CI) 42.9 to 44.9) of women had a Pap smear and 2.5% had colposcopy (95% CI 2.4 to 2.6). Two and a half percent of 15 to 24 year old women had colposcopy (95% CI 1.9 to 3.1). The ratio of women having Pap smears to women having colposcopy was 17-8:1 (95% CI 17.7 to 17.9). An estimated 247 women had colposcopy for every cervical cancer death; in the 15 to 24 year old age group this ratio was 47900:1. A 15 year old woman exposed to current rates of colposcopy (adjusted for hysterectomy) has a 76.8% chance of having a colposcopy during her life time. CONCLUSIONS - Many more women will have colposcopy than will develop cervical cancer, which undermines the cost effectiveness of Australia's cervical cancer screening programme.

Background: During the 1970s, the Papanicolaou method of classifying cervical cytology specimens and reporting diagnoses was replaced by more descriptive reporting systems. The plethora of reporting terms caused much confusion and a lack of standardization. To improve this situation, "The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses" was approved at a National Cancer Institute Workshop in 1988. In Australia, the Victorian Cervical Cytology Registry (VCCR) was established in 1989. Because of the absence of a standard format for reporting cervical cytology in that country, a coding schedule was developed by local cytopathologists. While the pattern of reporting smear diagnoses was found to be reasonably consistent within individual laboratories, substantial variation in reporting abnormal cervical smear diagnoses by 29 laboratories in Victoria, Australia, was observed. In 1992, a working party of the National Health and Medical Research Council of Australia proposed that a modified Bethesda System be adopted by Australian laboratories., Purpose: The aim of this study was to promote more uniform reporting of cervical/vaginal cytologic diagnoses by cytopathology laboratories in Victoria, Australia., Methods: From the computer database, VCCR staff identified 80 slides that had been registered during the first half of 1991 and that covered the range of low-grade reports and negative reports. Each slide was identified by research number only. Two sets of 40 slides were compiled. Of the 29 laboratories that had worked with the VCCR during 1991, 22 agreed to participate in this study in 1992. One slide set was sent to each laboratory. An evaluation of the intralaboratory and interlaboratory consistency in reporting a set of 40 slides was undertaken. Analysis of the results compared the degree of consistency using current descriptive terminology that operates locally in Victoria with that which would pertain if the proposed Australian modification to the Bethesda System were adopted., Results: Intralaboratory agreement with previously reported slides was low on the squamous descriptor (49% agreement with original report) but higher on the human papillomavirus descriptor (76% agreement with original report) when the results were analyzed using the current terminology. Wide variation in reporting was apparent between laboratories; only 5% of the slides had agreement by all laboratories. Both intralaboratory and interlaboratory agreement improved substantially when results were grouped into the categories of the proposed Australian modification of the Bethesda Reporting System., Conclusion and Implication: Substantial improvement in the consistency of reporting cervical cytology specimens would be likely if terminology incorporating the broad categories of the Bethesda System were adopted.

An analysis of cytology reporting within Victorian Cytology Service demonstrates that the proportion of Papanicolaou smears which were reported as including an endocervical component increased from approximately one half during 1987-89 to more than three quarters during 1990-91. The improvement coincided with the routine provision of special sampling instruments to all practitioners supplemented by an education program. Despite the increase in endocervical sampling, no increase in the rate of reporting of high-grade intraepithelial lesions of the cervix has occurred. An increase between the two time periods in the cytological reporting of adenocarcinoma, adenocarcinoma in situ and endocervical dyskaryosis has occurred, but does not reach statistical significance.

Regular participation in a high-quality screening program by all 'at risk' women is necessary if Australia is to be maximally successful in preventing cervical cancer. This paper discusses the use of reminder letters as one method of facilitating participation. Options for the source of the letters are discussed. It is concluded that basing the recall letters on a register of previously screened women is the only feasible approach within the Australian health care system. The impact of reminder letters on achieving regular participation by Australian women remains to be tested.

Pap smears reported by the Victorian Cytology (Gynaecological) Service between 1980 and 1987 for teenagers show a profile of abnormality which is similar to that for women for all ages. More than 90% of the cytology report have consistently been reported as normal or showing minor benign abnormalities only. No evidence of an increasing rate of infection with human papillomavirus is apparent, with the infection rate as determined cytologically being constant at around 4% to 5% during 1981 to 1987. Some increase in the proportion of women having associated changes of CIN is apparent. No case of invasive cancer in teenagers has yet been confirmed. These data suggest that the teenagers in Victoria who are having Pap smears reported by the Victorian Cytology (Gynaecological) Service are not a high risk group for cervical cancer during their teenage years, but may be a high risk group during later years.

Cytological evidence of human papillomavirus infection was present in 4.1% of the smear-tests that were received by the Victorian Cytology (Gynaecological) Service during 1982-1985. The prevalence rate among women was estimated to be 2.6% in 1984; for one-third of the women this was a change from their previous cytological status. The prevalence of papillomavirus infection was noted to vary with age and referral source; higher proportions were seen in the age group, 20-24 years, and in the cytological results of women who were attending either a sexually-transmitted diseases clinic or Aboriginal health cooperatives.

While it is known that anorexia nervosa patients show a wide range of sexual knowledge, attitudes and practices, the psychosexual histories of bulimia patients have not been studied. In this paper the psychosexual histories of 20 bulimic patients and 20 matched control subjects are presented. Bulimic patients were more likely to experience orgasm with masturbation, were more likely to have experimented with anal intercourse, and were more likely to describe their libido as 'above average.' Control subjects were more likely to experience orgasm during sexual intercourse. Bulimic patients associated high body weights with unattractiveness, and tended to withdraw from social and sexual activity at high weights. In other aspects of their sexual behaviour, and in their attitudes to sexual matters, the two groups were similar.

A review of published studies that have evaluated cervicography as a screening-test for the presence of cervical cancer is presented. Significant problems with the use of cervicography at a population level can be anticipated, in particular, a high proportion of women with uninterpretable test-results and an unacceptably-low positive predictive value. Colposcopy was unable to distinguish adequately the true status of many women with suspicious cervicograms; half the women with a cervicogram that was suggestive of cancer and an abnormal result by colposcopy had normal or benign histological findings. The impact of cervicography on the morbidity and mortality of cervical cancer is unproved. On current evidence, cervicography would not appear to be suitable for use as a screening-test, either as a replacement for, or as a supplement to, the Papanicolaou smear-test.

846 women with cytological evidence of human papillomavirus infection on their Papanicolaou smears in 1979 were followed for the subsequent development of cervical malignant disorders. Carcinoma-in-situ developed in 30 women during the next 6 years, compared with an expected number of 1.9 by general population incidence figures, giving a relative risk of 15.6. The risk was greatly increased (38.7) in women younger than 25 years when the cytological diagnosis of human papillomavirus infection was made.