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Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. [ABSTRACT FROM AUTHOR]

Objectives: We studied the association between cigarette smoking and ovarian cancer in a population-based case control study.Methods: A total of 794 women with histologically confirmed epithelial ovarian cancer who were aged 18-79 years and resident in one of three Australian states were interviewed, together with 855 controls aged 18-79 years selected at random from the electoral roll from the same states. Information was obtained about cigarette smoking and other factors including age, parity, oral contraceptive use, and reproductive factors. We estimated the relative risk of ovarian cancer associated with cigarette smoking, accounting for histologic type, using multivariable logistic regression to adjust for confounding factors.Results: Women who had ever smoked cigarettes were more likely to develop ovarian cancer than women who had never smoked (adjusted odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.2-1.9). Risk was greater for ovarian cancers of borderline malignancy (OR = 2.4; 95% CI = 1.4-4.1) than for invasive tumors (OR = 1.7; 95% CI = 1.2-2.4) and the histologic subtype most strongly associated overall was the mucinous subtype among both current smokers (OR = 3.2; 95% CI = 1.8-5.7) and past smokers (OR = 2.3; 95% CI = 1.3-3.9).Conclusions: These data extend recent findings and suggest that cigarette smoking is a risk factor for ovarian cancer, especially mucinous and borderline mucinous types. From a public health viewpoint, this is one of the few reports of a potentially avoidable risk factor for ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: There has been a major decline in mortality from coronary heart disease (CHD) in Australia from about 1967 through to 1989, occurring across all age groups simultaneously. We have analysed data up until 1992 to examine for trends within age cohorts.Methods: Death registrations for acute myocardial infarction and CHD were used to construct male and female 5-year age- and cohort-specific mortality rates starting at 1900-1904 for cohorts and 25-29 years for age. Trends within age group and within cohort were compared across time.Results: Across all female and most male birth cohorts there was a decrease in CHD mortality across the time period. In the youngest male cohorts there was a significant flattening in the rate of decline in the most recent periods. Comparison of age-specific mortality across cohorts showed the mortality at any period to be lower in the most recent cohort.Conclusions: This analysis demonstrates a continuing decline in mortality from CHD among females of all ages in Australia although the rate of decline appears to have slowed or even ceased in younger males. [ABSTRACT FROM AUTHOR]

Plastic adherent and non-adherent mononuclear cells derived from synovial fluid were found to stimulate peripheral blood mononuclear cells of patients with rheumatoid arthritis (RA) in an autologous mixed lymphocyte reaction (AMLR). Stimulation produced by adherent cells was consistently greater than that produced by non-adherent mononuclear cells. CD11 enriched cells were not significant stimulators in the AMLR, however their presence was required for a significant reaction to occur. Limiting dilution studies revealed that the most plausible model involved two or more cells of the same type in each of the stimulator and responder populations for the AM LR to occur. [ABSTRACT FROM AUTHOR]

Objectives: We describe the attitude and views of general practitioners towards the menopause and hormone replacement therapy (HRT) in metropolitan Brisbane, Australia.Methods: A total of 216 general practitioners were nominated by a random sample of urband-welling women aged 45-54 years who formed the Brisbane Women's health study. A 20-30 minute face-to-face questionnaire with the general practitioners was administered and analysed by demographic characteristics.Results: There was a 93% response rate. Management of the menopause and HRT was routinely undertaken by general practitioners for their own patients. After deciding to initiate HRT, > 60% of general practitioners ordered five investigations or more. They may have confused the risk of thrombo-embolism from oestrogens used in the post-menopause with that for contraception. There were differences between male and female practitioners in some areas. Male general practitioners, in particular, reported more difficulty with tailoring and adjusting regimes.Conclusions: Specific areas for further education are explored to meet the educational needs of general practitioners. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Lower socioeconomic status (SES) is associated in industrialized countries with unhealthy lifestyle characteristics, such as smoking, physical inactivity and being overweight or obese. This paper examines changes over time in the association between SES and smoking status, physical activity and being overweight or obese in Australia. METHODS: Data were taken from three successive national health surveys in Australia carried out in 1989-90 (n = 54,576), 1995 (n = 53,828) and 2001 (n = 26,863). Participants in these surveys were selected using a national probability sampling strategy, and aggregated data for geographical areas are used to determine the changing association between SES and lifestyle over time. FINDINGS: Overall, men had less healthy lifestyles. In 2001 inverse SES trends for both men and women showed that those living in lower SES areas were more likely to smoke and to be sedentary and obese. There were some important socioeconomic changes over the period 1989-90 to 2001. The least socioeconomically disadvantaged areas had the largest decrease in the percentage of people smoking tobacco (24% decrease for men and 12% for women) and the largest decrease in the percentage of people reporting sedentary activity levels (25% decrease for men and 22% for women). While there has been a general increase in the percentage over time of those who are overweight or obese, there is a modest trend for being overweight to have increased (by about 16% only among females) among those living in areas of higher SES. CONCLUSION: Socioeconomic inequalities have been increasing for several key risk behaviours related to health; this suggests that specific population-based prevention strategies intended to reduce health inequalities are needed. Copyright © 2006 World Health Organization [ABSTRACT FROM AUTHOR]

Road trauma is a significant health problem in rural and remote regions of Australia, particularly for Indigenous communities. This study aims to identify and compare the circumstances leading to (proximal causation) and social determinants of (distal causation) crashes of Indigenous and non-Indigenous people in these regions and their relation to remoteness. This is a topic seriously under-researched in Australia. Modelled on an earlier study, 229 persons injured in crashes were recruited from local health facilities in rural and remote North Queensland and interviewed, mainly by telephone, according to a fixed protocol which included a detailed narrative of the circumstances of the crash. A qualitative analysis of these narratives identified several core themes, further explored statistically in this sample, supplemented by participants in the earlier study with compatible questionnaire data, designed to determine which factors were more closely associated with Indigenous status and which with remoteness. Indigenous participants were less often vehicle controllers, more likely to have recently been a drink driver or passenger thereof; to be unemployed, unlicensed, distracted or fatigued before the crash, alcohol dependent and have lower perceived social, but not personal, locus of control in a traffic crash than non-Indigenous persons. Differences between Indigenous and non-Indigenous participants are largely ascribable to hardship and transport disadvantage due to lack of access to licensing and associated limitations on employment opportunities. Based on these findings, a number of policy recommendations relating to educational, enforcement and engineering issues have been made., Competing Interests: The authors declare no conflicts of interest.

Introduction: In mid-2007 the State of New South Wales (NSW) in Australia introduced modifications to the existing graduated driver licensing system, lengthening the mandatory number of supervised hours for learner drivers aged under 25 years from 50 to 120 and extending the minimum learner period from 6 to 12 months. Additional driving restrictions were also introduced for young drivers in the two provisional licensed periods, P1, P2. This paper aims to evaluate this change by comparing the crash and offense experiences of young learner drivers before and after it occurred., Method: From driver licensing files supplied by the NSW transport authority two cohorts of persons obtaining their initial learner's permits in the year prior to the changes and in the subsequent year were constructed with demographic data, dates of transition to the driving phases, dates of crashes, and dates and types of traffic offenses. Both cohorts comprised around 100,000 individuals. Crash rates per 100 years of person-time under observation post P1 with their standard errors were calculated. Using a survival-analytic approach the proportion of crashes of all types were graphed in three month periods post P1. Sexes were treated separately as were initial learner ages of 16, 17, 18-21, and 22-24 years. The distribution of traffic offense types during P1 and P2 phases were also compared. With such large numbers formal statistical testing was avoided., Results: No meaningful differences in the crash or offense experiences of the two cohorts in either sex or at any age were observed. Delaying progress to unsupervised driving has road safety benefits., Conclusions: At least in conditions similar to those in NSW, requiring more than 50 h of supervised driving seems to have few road safety benefits. Practical applications: Licensing authorities should be cautious in extending the mandated number of supervised driving hours beyond 50., (Copyright © 2019 Elsevier Ltd and National Safety Council. All rights reserved.)

Clozapine causes obesity and type 2 diabetes (T2DM). Glucagon-like peptide-1 (GLP-1) receptor agonists (e.g. exenatide) can counter clozapine-associated GLP-1 dysregulation in animals, and may be beneficial in people on clozapine. This randomized, controlled, open-label, pilot trial evaluated weekly exenatide for weight loss among clozapine-treated obese adults with schizophrenia, with or without T2DM. A total of 28 outpatients were randomized to once-weekly extended-release subcutaneous exenatide or usual care for 24 weeks. The primary outcome was proportion of participants with >5% weight loss. All 28 participants completed the study; 3/14 in the exenatide group and 2/14 in the usual care group had T2DM. Six people on exenatide achieved >5% weight loss vs one receiving usual care (P = .029). Compared with usual care, participants on exenatide had greater mean weight loss (-5.29 vs -1.12 kg; P = .015) and body mass index reduction (-1.78 vs -0.39 kg/m 2 ; P = .019), and reduced fasting glucose (-0.34 vs 0.39 mmol/L; P = .036) and glycated haemoglobin levels (-0.21% vs 0.03%; P = .004). There were no significant differences in other metabolic syndrome components. Exenatide may be a promising therapeutic agent for glycaemic control and weight loss in clozapine-treated people with obesity, and could assist in reducing clozapine-associated cardio-metabolic morbidity and mortality., (© 2017 John Wiley & Sons Ltd.)

Clozapine is the most effective antipsychotic for the 25% to 33% of people with schizophrenia who are treatment resistant, but not all people achieve response. Using data from a previously published clozapine systematic review and meta-analysis, we explored the proportion of people who achieved response and examined the absolute and percentage change in Positive and Negative Syndrome Scale (PANSS) scores. Overall, 40.1% (95% confidence interval [CI], 36.8%-43.4%) responded, with a mean reduction in PANSS of 22.0 points (95% CI, 20.9-23.1), a reduction of 25.8% (95% CI, 24.7%-26.9%) from baseline. These reductions are clinically meaningful. A 40% response rate to clozapine suggests that 12% to 20% of people with schizophrenia will be ultra-resistant.

The second year of life is a time of rapid developmental changes. This paper aims to describe the pattern of unintentional injuries to one-year old children in three-month age bands to better understand the risks associated with developmental stages and, therefore, identify opportunities for proactive prevention. Injury surveillance data were used to identify children admitted to hospital in Queensland, Australia for an unintentional injury from 2002-2012. Falls were the most common injury, followed by burns and scalds, contact injuries and poisonings. Falls and contact injuries remained roughly constant by age, burns and scalds decreased and poisonings (by medications) increased. Animal- and transport-related injuries also became more common, immersions and other threats to breathing less common. Within the falls and contact categories falls from play equipment and injuries due to contact with persons increased, while falls down stairs and catching fingers in doors decreased. The pattern of injuries varies over the second year of life and is clearly linked to the child's increasing mobility and boldness. Preventive measures for young children need to be designed-and evaluated-with their developmental stage in mind, using a variety of strategies, including opportunistic, developmentally specific education of parents; and practitioners should also consider potential for lapses in supervision and possible intentional injury in all injury assessments.