Population-based mammography screening and breast cancer incidence in New South Wales, Australia

To analyse breast cancer incidence trends in New South Wales (NSW), Australia, in relation to population-based mammography screening targeting women aged 50 to 69 years. Trends in age-specific incidence of invasive breast cancers in NSW women aged >= 40 years were examined in relation to mammography screening rates and screening cancer detection rates. Incidence of invasive breast cancer in NSW women increased in all age-groups over 1972 to 2002. The incidence trend for women aged 50 to 69 years showed that the steepest rise was associated with increased participation in population-based mammography screening, which was implemented from 1988 and achieved state-wide coverage in 1995. The elevated incidence of invasive cancer significantly exceeded pre-screening levels, and persisted after rates of initial screens declined. This elevated incidence was sustained by the contribution of cancers diagnosed through subsequent screening, and resulted from increased cancer detection rates in subsequent screens. The recent increase in invasive breast cancer incidence in NSW is associated with mammography screening, and occurred mostly in the target age-group women. Persistence of higher incidence after 1994 was not explicable by inflation of cancer incidence due to detection of prevalent screen cases, but was associated with a trend of increased cancer detection rates in subsequent screening rounds, probably consequent to quality improvements in mammography screening diagnosis.

The role of physiological understanding in plant breeding; From a breeding perspective

The role of physiological understanding in improving the efficiency of breeding programs is examined largely from the perspective of conventional breeding programs. Impact of physiological research to date on breeding programs, and the nature of that research, was assessed from (i) responses to a questionnaire distributed to plant breeders and physiologists, and (ii) a survey of literature abstracts. Ways to better utilise physiological understanding for improving breeding programs are suggested, together with possible constraints to delivering beneficial outcomes. Responses from the questionnaire indicated a general view that the contribution by crop physiology to date has been modest. However, most of those surveyed expected the contribution to be larger in the next 20 years. Some constraints to progress perceived by breeders and physiologists were highlighted. The survey of literature abstracts indicated that from a plant breeding perspective, much physiological research is not progressing further than making suggestions about possible approaches to selection. There was limited evidence in the literature of objective comparison of such suggestions with existing methodology, or of development and application of these within active breeding programs. It is argued in this paper that the development of outputs from physiological research for breeding requires a good understanding of the breeding program(s) being serviced and factors affecting its performance. Simple quantitative genetic models, or at least the ideas they represent, should be considered in conducting physiological research and in envisaging and evaluating outputs. The key steps of a generalised breeding program are outlined, and the potential pathways for physiological understanding to impact on these steps are discussed. Impact on breeding programs may arise through (i) better choice of environments in which to conduct selection trials, (ii) identification of selection criteria and traits for focused introgression programs, and (iii) identifying traits for indirect selection criteria as an adjunct to criteria already used. While many breeders and physiologists apparently recognise that physiological understanding may have a major role in the first area, there appears to be relatively Little research activity targeting this issue, and a corresponding bias, arguably unjustified, toward examining traits for indirect selection. Furthermore, research on traits aimed at crop improvement is often deficient because key genetic parameters, such as genetic variation in relevant breeding populations and genetic (as opposed to phenotypic) correlations with yield or other characters of economic importance, are not properly considered in the research. Some areas requiring special attention for successfully interfacing physiology research with breeding are discussed. These include (i) the need to work with relevant genetic populations, (ii) close integration of the physiological research with an active breeding program, and (iii) the dangers of a pre-defined or narrow focus in the physiological research.

Mild myocardial infarction - A classification problem in epidemiologic studies

In studies assessing the trends in coronary events, such as the World Health Organization (WHO) MONICA Project (multinational MONItoring of trends and determinants of CArdiovascular disease), the main emphasis has been on coronary deaths and non-fatal definite myocardial infarctions (MI). It is, however, possible that the proportion of milder MIs may be increasing because of improvements in treatment and reductions in levels of risk factors. We used the MI register data of the WHO MONICA Project to investigate several definitions for mild non-fatal MIs that would be applicable in various settings and could be used to assess trends in milder coronary events. Of 38 populations participating in the WHO MONICA MI register study, more than half registered a sufficiently wide spectrum of events that it was possible to identify subsets of milder cases. The event rates and case fatality rates of MI are clearly dependent on the spectrum of non-fatal MIs, which are included. On clinical grounds we propose that the original MONICA category ''non-fatal possible MI'' could bt:divided into two groups: ''non fatal probable MI'' and ''prolonged chest pain.'' Non-fatal probable MIs are cases, which in addition to ''typical symptoms'' have electrocardiogram (EGG) or enzyme changes suggesting cardiac ischemia, but not severe enough to fulfil the criteria for non-fatal definite MI In more than half of the MONICA Collaborating Centers, the registration of MI covers these milder events reasonably well. Proportions of non-fatal probable MIs vary less between populations than do proportions of non fatal possible MIs. Also rates of non-fatal probable MI are somewhat more highly correlated with rates of fatal events and non-fatal definite MI. These findings support the validity of the category of non-fatal probable MI. In each center the increase in event rates and the decrease in case-fatality due to the inclusion of non-fatal probable MI was lar er for women than men. For the WHO MONICA Project and other epidemiological studies the proposed category of non-fatal probable MIs can be used for assessing trends in rates of milder MI. Copyright (C) 1997 Elsevier Science Inc.

Hydraulic tracer studies in a pilot scale subsurface flow constructed wetland

Current design procedures for Subsurface Flow (SSF) Wetlands are based on the simplifying assumptions of plug flow and first order decay of pollutants. These design procedures do yield functional wetlands but result in over-design and inadequate descriptions of the pollutant removal mechanisms which occur within them. Even though these deficiencies are often noted, few authors have attempted to improve modelling of either flow or pollutant removal in such systems. Consequently the Oxley Creek Wetland, a pilot scale SSF wetland designed to enable rigorous monitoring, has recently been constructed in Brisbane, Australia. Tracer studies have been carried out in order to determine the hydraulics of this wetland prior to commissioning it with sealed sewage. The tracer studies will continue during the wetland's commissioning and operational phases. These studies will improve our understanding of the hydraulics of newly built SSF wetlands and the changes brought on by operational factors such as biological films and wetland plant root structures. Results to date indicate that the flow through the gravel beds is not uniform and cannot be adequately modelled by a single parameter, plug flow with dispersion, model. We have developed a multiparameter model, incorporating four plug flow reactors, which provides a better approximation of our experimental data. With further development this model will allow improvements to current SSF wetland design procedures and operational strategies, and will underpin investigations into the pollutant removal mechanisms at the Oxley Creek Wetland. (C) 1997 IAWQ. Published by Elsevier Science Ltd.

Performance on tests sensitive to impaired executive ability in schizophrenia, mania and well controls: acute and subacute phases

Aims: To compare the performance of schizophrenia, mania and well control groups on tests sensitive to impaired executive ability, and to assess the within-group stability of these measures across the acute and subacute phases of psychoses. Method: Recently admitted patients with schizophrenia (n=36), mania (n=18) and a well control group (n=20) were assessed on two occasions separated by 4 weeks. Tests included: the Controlled Oral Word Association Test, the Stroop Test, the Wisconsin Card Sort Test, and the Trail Making Test. Results: The two patient groups were significantly impaired on the Stroop Test at both time points compared to the control group. Significant group differences were also found for the Trail Making Test at Time 1 and for the Wisconsin Card Sort Test at Time 2. When controlled for practice effect, significant improvements over time were found on the Stroop and Trail Making tests in the schizophrenia group and on WCST Categories Achieved in the mania group. Discussion: Compared to controls, the patient groups were impaired on measures related to executive ability. The pattern of improvement on test scores between the acute and subacute phases differed between patients with schizophrenia versus patients with mania. (C) 1997 Elsevier Science B.V.

Visitor profiles and environmental attributes, especially of birds, attracting visitors to Lamington National Park: Tourist attitudes and economic issues

Uses a sample of 622 day and overnight visitors to the O’ Reilly’s/Green Mountains site of Lamington National Park, Queensland, Australia, to identify their socio-economic and other pertinent characteristics and the main reasons and attributes that attract them to the site. Particular attention is given to birds and their attributes as attractions. The primary economic injection accruing locally as a result of visits is examined and the difference that the presence of birds makes to local expenditure by visitors is explored. The extent of support for and objection to the introduction of a fee for entering Lamington National Park is estimated. The many suggestions received from visitors for environmental improvements at this site are discussed. It is suggested that unless a way can be found to regulate the number of visitors to this site and obtain extra funds to finance improvements at this site, the magnitude of many of these problems will grow. This will necessitate a fresh look at the desirability or otherwise for charging entry fees to Lamington National Park.

Closing the gender gap in Bangladesh: Inequality in education, employment and earnings

Assesses the status of women in Bangladesh by analysing the dynamics of female participation in labour force and education as well as gender earnings differentials at the macro level. The study finds evidence of growing commercialisation of women’s work in Bangladesh. Although the bulk of the female labour force is engaged in self-employment activities in the rural area or in low-skilled textile and readymade garment industries in the urban area, women’s participation in high-skill and entrepreneurial jobs as well as various decision-making bodies is also on the rise. While the gender wage differentials have been considerably reduced in many industries, in general women tend to be paid less than men. There have been remarkable improvements in women’s educational attainments compared to men. Further, female access to education is found to be highly correlated with overall female labour force participation, and relative to male participation. The overall results are suggestive of an improvement in the status of women in Bangladesh.

Closure of the Challinor Centre II: An extended report on 95 individuals after 12 months of community living

As part of an institutional closure programme, 95 individuals with an intellectual disability were relocated to community-based group homes. Each individual was assessed 6 months prior to the relocation and then again after 1, 6, and 12 months of community living. Assessments involved ratings of adaptive and maladaptive behaviour, choice-making, and life circumstances. The group means comparing institution to community ratings showed improvements in adaptive functioning but no significant change in maladaptive behaviour. There were also improvements in life circumstances and increased opportunities for choice-making following relocation to the community. These outcomes suggest that relocation to the community was associated with a more active and normalised lifestyle than experienced in the institutional setting.

Diversity and commonality in national identities: an exploratory analysis of cross-national patterns

Issues of boundary maintenance are implicit in all studies of national identity. By definition, national communities consist of those who are included but surrounded (literally or metaphorically) by those who are excluded. Most extant research on national identity explores criteria for national membership largely in terms of official or public definitions described, for example, in citizenship and immigration laws or in texts of popular culture. We know much less about how ordinary people in various nations reason about these issues. An analysis of cross-national (N = 23) survey data from the 1995 International Social Science Program reveals a core pattern in most of the countries studied. Respondents were asked how important various criteria were in being 'truly' a member of a particular nation. Exploratory factor analysis shows that these items cluster in terms of two underlying dimensions. Ascriptive/objectivist criteria relating to birth, religion and residence can be distinguished from civic/voluntarist criteria relating to subjective feelings of membership and belief in core institutions. In most nations the ascriptive/objectivist dimension of national identity was more prominent than the subjective civic/voluntarist dimension. Taken overall, these findings suggest an unanticipated homogeneity in the ways that citizens around the world think about national identity. To the extent that these dimensions also mirror the well-known distinction between ethnic and civic national identification, they suggest that the former remains robust despite globalization, mass migration and cultural pluralism. Throughout the world official definitions of national identification have tended to shift towards a civic model. Yet citizens remain remarkably traditional in outlook. A task for future research is to investigate the macrosociological forces that produce both commonality and difference in the core patterns we have identified.

Rehabilitation outcomes following percutaneous coronary interventions (PCI)

This prospective study evaluated the effect of an individualized, comprehensive, home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors, psychological wellbeing, functional capacity, and work resumption in 99 post-percutaneous coronary interventions (PCI) patients randomized to control (standard care plus telephone follow-up, n = 49) or intervention (individualized, comprehensive, home-based cardiac rehabilitation, n = 50) groups. Data were collected at time 1 (T-1) during hospital admission, time 2 (T-2) approximately 2 months post-PCI, and time 3 (T-3) approximately 12 months post-PCI. Results suggest that the allocation to an individualized, comprehensive, home-based cardiac rehabilitation program provided more advantageous outcomes. At both follow-ups, the intervention group showed within-group improvement in serum cholesterol levels (P < 0.02; P < 0.01) and exercise participation (P < 0.001; P < 0.001) with differences in exercise participation favoring the intervention group (P < 0.01) at T-2 Repeated measures ANOVA showed significant improvements over time in body mass index (BMI) (P < 0.01), psychological well-being (P < 0.001), and functional capacity (P < 0.001) for both groups. More patients in the intervention group had returned to work at T-2 (P < 0.001) and did so more quickly (P < 0.01). These findings suggest that an individualized, comprehensive, home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.

Individual and societal bases of national identity - A comparative multi-level analysis

In a previous study (Jones and Smith, 1999) we established that much the same core pattern of national identity characterizes many developed countries. Using the national identity module from the 1995 International Social Survey Programme, we identified two dimensions of national identity: an ascriptive dimension resembling the concept of ethnic identity described in the historical and theoretical literature, and a voluntarist dimension closer to the notion of civic identity. Some writers view these dimensions in terms of a historical sequence but we find that both constructs coexist in the minds of individual respondents in the nations we examine (we exclude Bulgaria and the Philippines from the present but not the earlier analysis). The dataset used for the multilevel analyses reported here consists of 28 589 respondents in the remaining 21 countries included in the national identity database for the 1995 round of surveys. The macrosociological literature on national identity does not offer well-defined predictions about what precise patterns of national identification we might expect to find among the masses of the developed countries. There are, however, recurring themes from which one can construct plausible hypotheses about how countries might differ according to their level of development, broadly conceived. Thus, we hypothesize that forces such as post-industrialism and globalization tend to favour the more open voluntaristic form of national identity over the more restrictive ascribed form. We develop different multi-level models in order to evaluate specific hypotheses pertaining to such issues, by simultaneously relating individual and societal characteristics to the relative strength of individual commitment to these different types of national identity.

Drug use evaluation of ipratropium bromide at two tertiary referral hospitals in Brisbane.

Objective: To assess the appropriateness of ipratropium bromide prescribing in two tertiary referral hospitals. Method: Criteria for optimal use were developed based on current literature and modified after consultation with respiratory physicians and clinical pharmacists. A prospective review of prescribing was performed over a 2-month period to assess conformity to these criteria. Results: Information was collected from 84 patients; 5% were receiving inhalers and 96% nebuliser therapy (one patient used both). 77% of patients (n = 65) had a principal diagnosis of chronic obstructive pulmonary disease, 14% (n = 12) asthma and 8% (n = 7) had neither diagnosis. 75% of patients were using ipratropium outside the guidelines. The major areas where the guidelines were not met were a lack of therapeutic justification, use of inappropriate doses, and use of an inappropriate delivery device. Feedback and educational interventions were designed and delivered based on the data obtained. Conclusions: There was widespread use of ipratropium outside the developed guidelines. Interventions in specific areas could lead to significant improvements in the use of this high cost drug

Adult Growth Hormone Deficiency. What does the newest hormone replacement therapy do?

All patients with known pituitary or hypothalamic disease, or surgery or radiation treatment to the area could have growth hormone deficiency. Growth hormone deficiency in adults is an approved indication for recombinant growth hormone treatment in Australia. Diagnosis currently requires measurement of growth hormone response to insulin hypoglycaemia. Many patients have dramatic improvements in body composition, functional capacity and psychological wellbeing following recombinant human growth hormone replacement. (author abstract)