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Objectives: Anal cytology smears are either collected "blind" (swab inserted 4 cm into anal canal and rotated) or guided through an anoscope (transformation zone visualised and then sampled). We compared these smear techniques with respect to sample quality and patient acceptability., Methods: Using a paired, random sequence clinical trial, 151 homosexual men (n = 95 HIV positive) underwent both smear techniques at a single visit; smear order was randomised and specimens were read blind. Both techniques utilised a Dacron swab, with water lubrication. Cytological specimens were prepared using a liquid based collection method (ThinPrep). The outcome measures were cytological specimen adequacy, cytological classification, presence of rectal columnar, squamous and metaplastic cells, contamination, patient comfort and acceptability, and volume of fluid that remained after the ThinPrep procedure., Results: Regardless of smear order, guided smears were less likely to detect higher grade abnormalities than blind smears (15 v 27 cases, p = 0.001). Controlling for smear order, guided smears were more likely to be assessed as "unsatisfactory" for cytological assessment (OR 6.93, 95% CI 1.92 to 24.94), and contain fewer squamous (OR 0.20, 95% CI 0.04 to 0.94) and metaplastic cells (OR 0.12, 95% CI 0.03 to 0.54) than blind smears; there were no other statistically significant differences between techniques. Regardless of smear technique, first performed smears were more likely to detect a higher grade abnormality than second performed smears (23 v eight cases, p < 0.001)., Conclusions: Blind cytology smears are superior to anoscope guided smears for screening for anal neoplasia in homosexual men.

Objective: Several studies have suggested that there is an occupational component to the causation of non-Hodgkin lymphoma (NHL). We aimed to use accurate means to assess occupational exposures to solvents, metals, organic dusts and polychlorinated biphenyls (PCBs) in a case-control study., Methods: Cases were incident NHLs during 2000 and 2001 in two regions of Australia. Controls were randomly selected from the electoral roll and frequency matched to cases by age, sex and region. A detailed occupational history was taken from each subject. For jobs with likely exposure to the chemicals of interest, additional questions were asked by telephone interview using modified job specific modules. An expert allocated exposures using the information in the job histories and the interviews. Odds ratios were calculated for each exposure adjusting for age, sex, region and ethnic origin., Results: 694 cases and 694 controls (70 and 45 respectively of those potentially eligible) participated. The risk of NHL was increased by about 30 for exposure to any solvent with a dose response relationship, subgroup analysis showed the finding was restricted to solvents other than benzene. Exposure to wood dust also increased the risk of NHL slightly. Exposures to other organic dusts, metals, and PCBs were not strongly related to NHL., Conclusions: The risk of NHL appears to be increased by exposure to solvents other than benzene and possibly to wood dust.

Background: Immune deficiency is a strong risk factor for non-Hodgkin lymphoma (NHL), but whether or not other forms of immune dysregulation are associated with NHL risk is unknown. We investigated associations between atopy, which is associated with a Th2-dominant immune response, and NHL risk. Because late birth order and childhood crowding are inversely associated with atopy, we also investigated their associations with NHL risk., Methods: We carried out a population-based case-control study among adults aged 20-74 years in New South Wales and the Australian Capital Territory, Australia. NHL patients without clinically apparent immune deficiency (N = 704) were selected from a cancer registry, and control subjects (N = 694) were randomly selected from state electoral rolls and frequency-matched to case patients by age, sex, and area of residence. Birth order, childhood crowding, and history of atopic conditions (hay fever, asthma, eczema, and specific allergies) were assessed by questionnaire and interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from logistic regression models that included the matching variables as covariates., Results: The odds ratios for developing NHL were 0.52 (95% CI = 0.32 to 0.84) for only children, 0.55 (95% CI = 0.40 to 0.75) for first-born children, 0.70 (95% CI = 0.51 to 0.96) for second-born children, and 0.81 (0.57 to 1.14) for third-born children (all compared with fourth- or later-born children) (P(trend)<.001). Indicators of crowding in later childhood, such as sharing a bed or bedroom, were not associated with NHL risk. A history of atopic conditions was associated with a reduced risk of NHL; this reduction was statistically significant for hay fever (OR = 0.65, 95% CI = 0.52 to 0.82) and food allergies (OR = 0.29, 95% CI = 0.20 to 0.42)., Conclusions: Early birth order and its immunologic consequence, a Th2-dominated immune response, as reflected by a history of atopic disease, are associated with a reduced risk of NHL.

Objectives: To determine by systematic review the prevalence of genital chlamydial infection in Australia between 1997 and 2004., Methods: Electronic literature databases, reference lists, and conference proceedings were searched and health agencies and jurisdictions were contacted for published and unpublished reports. Studies were eligible if they offered a diagnostic nucleic acid amplification test to consecutive individuals presenting during the study period. As a summary measure of the available data, mean prevalence rates, weighted by sample size and irrespective of participant age, were calculated for the population sub-groups., Results: 40 studies of 50 populations and 40,587 individuals met the inclusion criteria, but only one of these was population-based. The use of non-systematic methodologies prevented an assessment of time trends and a statistical comparison of population sub-groups. The mean overall prevalence of genital chlamydial infection was 4.6% (95% CI 4.4-4.8%), reflecting over-sampling of high-risk groups. The mean community-based rates were 7.5% (95% CI 6.4-8.6%) and 8.7% (95% CI 7.9-9.7%) for Indigenous men and women, and 1.5% (95% CI 1.1-1.9%) and 1.4% (95% CI 0.9-2.0%) for non-Indigenous men and women. The overall mean estimates for other groups were 3.3% (95% CI 3.0-3.7%) for female attendees of sexual health and related clinics, 5.6% (95% CI 4.9-6.4%) for adolescents and young adults, 3.3% (95% CI 2.8-3.9%) for sex workers, and 1.6% (95% CI 1.2-2.0%) for urethral infection in men who have sex with men. Clinic-based estimates were generally, although not consistently, higher than community-based estimates. There is no serial population-based data for sexually active young men and women, but the available age-specific rates suggest under-ascertainment by the routine surveillance systems., Conclusions: The prevalence of genital chlamydial infection in Indigenous Australians and young adults is unacceptably high and quality epidemiological studies are urgently required to supplement the routinely collected national notification data.

Ultraviolet radiation is a hypothesised risk factor for non-Hodgkin lymphoma (NHL) but no epidemiological study has examined this association using direct measures of sun exposure in individuals. Adults aged 20-74 years living in NSW and ACT, Australia, were the study population. Cases (704 of 829 invited to take part, 85%) were diagnosed January 2000 to August 2001. Controls (694 of 1,136 invited to take part, 61%) were randomly selected from state electoral rolls and frequency-matched to cases by age, sex and state of residence. A self-administered questionnaire and telephone interview measured outdoor hours on working and nonworking days and vacations at 10, 20, 30, 40, 50 and 60 years of age. Logistic regression models of NHL and sun exposure contained the 3 matching variables, ethnicity and sun sensitivity measures as covariates. Contrary to expectations, risk of NHL fell with increasing reported sun exposure hours. Relative to 1.0 for the lowest quarter of total sun exposure hours, the odds ratios (ORs) for successively higher quarters were 0.72 (95% CI 0.53-0.98), 0.66 (0.48-0.91) and 0.65 (0.46-0.91) (p(trend)=0.01). The association of sun exposure on nonworking days with NHL was stronger; OR for highest quarter 0.47 (0.34-0.66) (p(trend)=0.0001). Risk also fell with sun exposure on vacations; OR for highest quarter 0.60 (0.43-0.85) (p(trend)=0.003). These associations appeared strongest in women and in childhood. There was little evident trend in risk with exposure on working day. Our results provide strong statistical evidence for an inverse association between sun exposure and NHL. Increasing evidence that vitamin D may protect against cancer makes UV-mediated synthesis of vitamin D a plausible mechanism whereby sun exposure might protect against NHL., ((c) 2004 Wiley-Liss, Inc.)

We examined risk of ocular melanoma with exposure to artificial sources of exposure to ultraviolet radiation (UVR) in a population-based epidemiologic study of 290 cases of ocular melanoma and 893 controls aged 18-79 years in Australia in 1996-1998. Cases were identified through a prospective survey of all ophthalmologists and cancer registries in Australia; 91.8% participated. Controls were sourced from electoral rolls; 67.4% of those who were eligible and contactable participated, while 27.3% could not be contacted. Exposure to welding and use of sunlamps, including sunbeds and tanning booths, was measured by telephone interview. Analyses used unconditional logistic regression and included age, sex, region of birth, eye color, ocular and cutaneous sun sensitivity and personal sun exposure as covariates. Risk of choroid and ciliary body melanoma in 246 cases increased significantly with longer duration of use of sunlamps, first use before 21 years of age and first use after 1980. These effects were independent of personal sun exposure. Risk of these melanomas also increased with increasing duration of welding exposure, although the trend was not significant overall. There was no evidence that these exposures increased the risk of iris (n = 25) or conjunctival (n = 19) melanomas. Personal exposure to sunlamps and welding predicts risk of choroid and ciliary body melanoma in Australia., ((c) 2004 Wiley-Liss, Inc.)

We report on pigmentary characteristics, sun sensitivity and some other possible risk factors for non-Hodgkin lymphoma (NHL) in people 20-74 years of age. A statewide case-control study was conducted in New South Wales, Australia, with population-based sampling of cases (n = 704) and controls (n = 694). Risk of NHL was increased in subjects with hazel eyes (OR = 1.48; 95% CI = 1.07-2.04), very fair skin (OR = 1.44; 95% CI = 1.01-2.07) and poor ability to tan (OR = 1.70; 95% CI = 1.06-2.71). Risk with mild facial freckling as a child (OR = 0.77; 95% CI = 0.59-0.99) was reduced relative to that with no or moderate to severe freckling. Smokers were not at increased risk of NHL. A past history of treatment for skin cancer was associated with a slight nonsignificant increase in risk. Previous radiotherapy and chemotherapy were associated with 1.5- to 2-fold increases in risk but with wide confidence intervals. These results provide weak support for the possibility that sun sensitivity or perhaps sun exposure increases risk of NHL., (Copyright 2004 Wiley-Liss, Inc.)

To define the location of potential oncogenes and tumor suppressor genes in ocular melanoma we carried out comparative genomic hybridization (CGH) analysis on a population-based series of 25 formalin-fixed, paraffin-embedded primary tumors comprising 17 choroidal, 2 ciliary body, 4 iris, and 2 conjunctival melanomas. Twelve (48%) of the 25 melanomas showed no chromosomal changes and 13 (52%) had at least one chromosomal gain or loss. The mean number of CGH changes in all tumors was 3.3, with similar mean numbers of chromosomal gains (1.5) and losses (1.8). The highest number of chromosomal changes (i.e., nine) occurred in a conjunctival melanoma and included four changes not observed in tumors at any other ocular site (gains in 22q and 11p and losses in 6p and 17p). The most frequent gains in all primary ocular melanomas were on chromosome arm 8q (69%), 6p (31%) and 8p (23%) and the most frequent losses were on 6q (38%), 10q (23%), and 16q (23%). The most common pairing was gain in 8p and gain in 8q, implying a whole chromosome copy number increase; gains in 8p occurred only in conjunction with gains in 8q. The smallest regions of copy number alteration were mapped to gain of 8q21 and loss of 6q21, 10q21, and 16q22. Sublocalization of these chromosomal changes to single-band resolution should accelerate the identification of genes involved in the genesis of ocular melanoma.

We studied the BRCA2 gene for germline mutations in 71 of 99 patients (72%) with ocular melanoma who were diagnosed consecutively in Australia in 1997 and 1998. Patients considered for our study fulfilled one of the following critiera: (i) were 50 years of age or less at diagnosis; (ii) had bilateral disease (2 patients); (iii) reported a family history of ocular melanoma (4 patients). Mutation detection was performed using the protein truncation test and denaturing high-performance liquid chromatography with primers designed to include intron-exon boundaries. Six DNA changes were found of which 2 were exonic, in exons 14 (A>C in nucleotide 7244 leading to His>Arg) and 27 (base pair substitution in nucleotide 9976 leading to a stop codon). One exonic change has been reported previously. None of the intronic mutations were deemed to affect splicing efficiency. Neither exonic mutation was in a person with bilateral ocular melanoma or a family history of cutaneous melanoma. We estimated the prevalence of possible loss of function changes in BRCA2 in patients with ocular melanoma at 3% (95% CI 0-10%). This figure was similar to previous estimates of 2.8% and 2% in nonrepresentative samples of patients with ocular melanoma and 2.1% in a representative sample of young women with breast cancer., (Copyright 2002 Wiley-Liss, Inc.)

Ethnicity, cutaneous nevi and eye color are generally accepted risk factors for melanoma of the eye, although case-control studies have produced conflicting results. We sought to determine the constitutional risk factors for melanomas of the choroid, ciliary body, iris and conjunctiva in Australia. A population-based case-control study was conducted, with case ascertainment from a prospective national incidence survey and randomly selected community controls. Two hundred and ninety cases aged 18-79 years and diagnosed between 1st January 1996 and 31st July 1998 were enrolled with 916 controls frequency matched by age, sex and State or Territory of residence. Risk of choroidal and ciliary body melanoma (n = 246) was increased in people with grey (OR 2.9, 95% CI 1.5-5.5), hazel (OR 2.2, 95% CI 1.4-3.7) and blue eyes (OR 1.7, 95% CI 1.0-2.7) compared with brown eyes. Risk was also increased in those with 4 or more nevi on their back, those unable to tan, and those who squinted when outdoors as a child. Risk was reduced in people born other than in Australia and New Zealand (OR 0.7, 95% CI 0.5-1.0). Non-brown eye color was a risk factor for iris melanoma (n = 25). No risk factors were identified for conjunctival melanoma (n = 19). Eye color is the strongest constitutional predictor of choroidal and ciliary body melanoma, and may indicate a protective effect of melanin density at these sites. An independent association with cutaneous nevi suggests a role for other genetic factors., (Copyright 2001 Wiley-Liss, Inc.)

Purpose: To establish whether the status of the pre-contact lens tear film as indicated by standard, clinical observational techniques is affected by moderate stimulation of the contralateral eye., Methods: Four indicators of tear film behavior, lipid layer appearance, amount of debris, inferior meniscus height and non-invasive tear break up time (NIBUT) were monitored in ten subjects before and during 30 minutes of monocular pHEMA contact lens wear. Concurrently, the contralateral eye was either subjected to moderate irritation by means of a silicone elastomer contact lens, or remained unstimulated. Data were compared, between the stimulated and unstimulated states to identify evidence of contralateral treatment effects., Results: After 30 minutes, maximum contralateral differences between the unstimulated and stimulated conditions were 1 grade for both lipid layer appearance and debris, 0.1 mm for meniscus height and 4 secs for NIBUT., Conclusions: The magnitudes of contralateral effects induced by moderate, monocular irritation were comparable with the within-subject variabilities associated with these indicators of tear film behavior.

Purpose: To establish the temporal sequence of limbal hyperaemia in humans without contact-lens wear and during conventional and highly oxygen-permeable soft-contact-lens wear., Methods: Two, 16-h, non-dispensing clinical studies were conducted, each incorporating 8 h of open eye with normal blinking, followed by 8 h of eye closure during sleep. In the first study, six non-habitual contact-lens wearers did not wear contact lenses. In the second study, the same subjects were each randomly assigned, in a double-masked fashion, to wear a conventional, thin, 38% water, pHEMA soft contact lens (SCL) in one eye and an experimental high Dk (EHD), 20%-water soft contact lens in the other. Limbal redness (LR) was graded, using a 0-4 scale with decimalised subdivisions, at baseline and after 4, 8 and 16 h. ANOVA was applied to the data, and the level for statistical significance was set at p < or = 0.005., Results: In the non-wearing eye, LR changes averaged 0.2 +/- 0.2 and 0.4 +/- 0.2 grades at 4 and 16 h, respectively (inferior quadrant). The corresponding values for SCL wear were 1.0 +/- 0.6 and 1.1 +/- 0.6, while for EHD wear they were 0.2 +/- 0.4 and 0.5 +/- 0.5. Both for the normal eye and those wearing EHD lenses, increases in LR were significant only during eye closure (p < 0.005). During SCL wear, significant and larger LR increases were seen after 4 h open eye wear (p < 0.005), with only relatively small further changes being observed over the next 12 h., Conclusions: SCL wear induces a marked increase in limbal hyperaemia during open-eye wear, which is not seen either in the no lens situation or when EHD lenses are worn. The pattern of limbal hyperaemia for both the open and closed eyes during EHD lens wear is very similar to that for the no-lens situation. The mechanism whereby SCL induces excess limbal hyperaemia has not been absolutely established, but it may involve local hypoxia.

We investigated the effect of overnight eye closure on the levels and types of microbiota in the external eye, the conjunctiva, and lid margins of 40 normal subjects during the day and immediately after eye opening following 8 hours of sleep over 3 consecutive days. Overall, clinically important levels of gram-positive bacteria were isolated from 22.1% of samples; 2.3% of samples yielded gram-negative bacterial growth. The incidence of clinically important levels of gram-positive bacteria was greater in closed-eye compared with open-eye samples. There was no significant increase in the incidence of gram-negative bacteria or fungi with eye closure. There was no difference between the open- and closed- eye samples with regard to types of microorganisms isolated. Our results suggest that eye closure may promote the growth of normal external ocular microbiota. These findings have implications for extended contact lens wear and ocular surgery.