The obesity paradox: effect of body mass index on 2-years clinical outcome after primary percutaneous coronary intervention in Indonesia.

OBJECTIVE: Several studies demonstrated that a high body mass index (BMI) might actually benefit patients with cardiovascular disease, including coronary heart disease. However, other studies were unable to confirm this paradoxical phenomenon in all populations. Therefore, this study aims to determine the association between BMI and long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS: This was a retrospective cohort study of 400 STEMI patients undergoing PCI. Clinical outcome evaluation was done by face-to-face or phone interview and collecting objective data. Statistical analysis was performed to compare the outcomes between underweight-normal group with overweight-obese group. RESULTS: The incidence of major adverse cardiovascular events (MACE) was lower in patients with higher BMI group in 2-years evaluation (24.1% vs. 39.9%; p < 0.001). Multivariate analysis showed that BMI was an independent predictor of MACE and the incidence of recurrent infarction (OR 2.322 [CI 95% 1.505-3.584; p < 0.001]). The risk of MACE reduces as the weight increases, with a nadir of risk reduction for MACE at 28 to 29.0 kg/m2, in which the curve rises after, but remained below the risk associated with BMI of 23 kg/m2. CONCLUSIONS: In our population, patients with high BMI have a lower incidence of long-term MACE, especially recurrent myocardial infarction, in patients with STEMI undergoing PCI.

Validity of self-reported skin screening histories.

Screening by whole-body clinical skin examination may improve early diagnosis of melanoma and reduce mortality, but objective scientific evidence of this is lacking. As part of a randomized controlled trial of population screening for melanoma in Queensland, Australia, the authors assessed the validity of self-reported history of whole-body skin examination and factors associated with accuracy of recall among 2,704 participants in 2001. Approximately half of the participants were known to have undergone whole-body skin examination within the past 3 years at skin screening clinics conducted as part of the randomized trial. All positive and negative self-reports were compared with screening clinic records. Where possible, reports of skin examinations conducted outside the clinics were compared with private medical records. The validity of self-reports of whole-body skin examination in the past 3 years was high: Concordance between self-reports and medical records was 93.7%, sensitivity was 92.0%, and specificity was 96.3%. Concordance was lower (74.3%) for self-reports of examinations conducted in the past 12 months, and there was evidence of "telescoping" in recall for this more recent time frame. In multivariate analysis, women and younger participants more accurately recalled their history of skin examinations. Participants with a history of melanoma did not differ from other participants in their accuracy of recall.

A randomised trial of population screening for melanoma.

OBJECTIVES: Melanoma is a significant cause of morbidity and mortality worldwide and incidence is increasing. Survival after treatment is inversely related to the thickness of the tumour at diagnosis. Population screening has the potential to reduce mortality but there is no conclusive evidence of benefit. Such evidence can come best from a randomised trial. Here we describe the design of a community based randomised trial of a population screening programme for melanoma in Queensland, Australia and early results of the first phase of the trial. METHODS: A total of 44 communities (aggregate population 560 000 adults aged 30 years or more) will be randomised to receive either a community based screening programme for 3 years or normal practice. The screening programme promotes thorough skin self examination and whole body skin examination by a doctor and provides open access skin cancer screening clinics. In its first phase, the trial is underway in nine intervention and nine control communities. The primary outcome measure is mortality from melanoma during 15 years of follow up. RESULTS: The first phase of the trial has shown the feasibility of implementing a population skin screening programme including regular skin cancer screening clinics, and has shown the strong support of communities and doctors for the programme. There has been a significant 2.5-fold increase in participation in screening in the intervention communities in this first phase after the first 12 months of the trial and no significant increase in participation in screening in control communities during this period. CONCLUSIONS: The design of a community based randomised trial of screening for melanoma has been successfully peer reviewed and the intervention has been shown to be feasible in practice. This randomised trial may be one of the last opportunities to develop the evidence required for public health recommendations for population screening for melanoma.

Reducing indigenous mortality in Australia: lessons from other countries.

Mortality rates from all causes in Maoris in New Zealand and Native Americans have fallen substantially since the early 1970s. Comparable mortality rates for Australian Aboriginals and Torres Strait Islanders in 1990-1994 were at or above the rates observed 20 years ago in Maoris and Native Americans, being 1.9 times the rate in Maoris, 2.4 times the rate in Native Americans, and 3.2 times the rate for all Australians. Circulatory diseases, respiratory diseases, injuries and endocrine diseases (mostly diabetes) are responsible for almost 70% of these excess deaths. Mortality rate trends in indigenous populations in other countries suggest the feasibility of substantial and rapid reductions in mortality rates of Australia's indigenous people.

Food insufficiency in Queensland.

To investigate the prevalence of food insufficiency and factors associated with it, two questions assessing household and individual food insufficiency were included in 13 regional health surveys conducted in Queensland in 1993. The surveys used computer-assisted telephone interviewing methodology. Of the 10,451 people interviewed, 9.7 per cent and 6.4 per cent reported household and individual food insufficiency, respectively, and 11.3 per cent reported at least one type. Prevalence was significantly higher in women than men and in urban than rural residents, and decreased monotonically with increasing age from 16.6 per cent in 18- to 30-year-olds to 1.7 per cent in over-70-year-olds. Higher prevalence also was associated with lower income, unemployment, single or separated, divorced or widowed status versus married (or de facto), one-adult households, and shared accommodation. Lower prevalence was associated with more education in those aged 50 and under but not in those over 50 years. Using logistic regression to control simultaneously for important sociodemographic factors, we found that risk of food insufficiency was most highly associated with age and income (threefold risk), unemployment and shared accommodation (twofold risk) and one-adult households, and being single versus separated, widowed or divorced (one-and-a-half-fold risk). Some differences in risks existed between men and women and between rural and urban residents, although none excluded the role of chance. Association of the items with lower reported fruit, vegetable and meat intake, poorer health status, and greater underweight supports their validity.

Telephone administration of the SF-36 health survey: validation studies and population norms for adults in Queensland.

The Rand Corporation medical outcomes short-form 36 health survey (SF-36) is a multidimensional measure of self-perceived general health status, which has been validated in adult populations in the United States and Great Britain, and, more recently, in an Australian population. The SF-36 is increasingly being used in health outcomes research internationally, mainly as a self-administered tool, and clearly has potential for use in Australia. This study aimed to assess the acceptability, reliability and validity of telephone administration of the instrument in the Queensland adult population, and to provide reliable population norms. We report the results of a telephone survey in which we interviewed 12,793 adults. It was the first large-scale, statewide application of the SF-36 in Australia. A response rate of 82 per cent was achieved, and the SF-36 satisfied psychometric criteria for reliability and construct validity. Population norms broken down by age and sex are provided. They will be important for the interpretation of future studies using the SF-36 in particular population or patient groups.

Factors associated with Pap smear taking in general practice: focusing public health initiatives.

This study ascertained the relationships of patient, practitioner and consultation factors with: 1. taking a Pap smear or referral to a specialist in the consultation; and 2. an unsuccessful offer to take a Pap smear or making an appointment for a smear. In a cross-sectional study of 3478 women presenting to 230 randomly selected general practitioners in Brisbane and Toowoomba, information about most recent Pap smear, screening in the consultation, and independent variables were collected from patients and doctors. Relationships between three levels of outcome variable (no action, Pap smear taken or referral, appointment or refusal), and independent variables (practitioner variables, consultation variables, patient variables) were modelled using polytomous logistic regression. Presenting for a routine checkup and breast cancer screening were associated with all types of action. Younger age, longer consultations and consultations with a female practitioner were associated with Pap smear taking and referrals, and not appointments or refusals. Being due for a Pap smear, having blood pressure measured, consulting a younger general practitioner and one who ascribed to current guidelines on screening were associated with an appointment or a refusal, when compared with no action. Results identify different profiles of those who get a Pap smear and those who do not, the former indicating a more proactive patient group, while the latter suggest more active general practitioners who attempted opportunistic screening of passive patients, or women who do not specifically seek Pap smears. We have identified factors that have significance for developing public health programs focused on consumers and providers.

Correlates of physician counseling associated with obesity and smoking.

BACKGROUND: Patient, physician, and consultation variables associated with overweight and smoking counseling in general practice consultations were examined. METHODS: A random sample of full-time general practitioners was used. The sample consisted of 7,160 patients from 230 GPs who attended for consultations on consecutive days, and self-reported information from the doctor and the patient was collected via questionnaire. The aim of this paper is to identify variables associated with the doctor's identification of overweight and smoking status and with the occurrence of counseling for these two behavioral risk factors. RESULTS: Forty percent of patients were overweight (BMI > 24) and 25% were self-reported smokers. Doctors identified 59% of overweight patients and 66% of smokers. Doctors only counseled patients identified as having the risk factor, counseling 36% of identified overweight patients and 49% of identified smokers. Identification of overweight was associated with being female, being heavier, having been previously counseled, being less well educated, presenting with an associated condition, and visiting a doctor who is younger and knows the patient's medical history well. Counseling for overweight was associated with being younger, being previously counseled, presenting with an associated condition, presenting for a routine checkup, visiting a GP who generally has longer consultations, having BP measured in the consultation, visiting an older doctor and visiting a doctor who considers identification of risk behaviors important. Identification of smokers was associated with being a heavier smoker, with those who had been previously counseled, with marital status other than single or married, with a BP measurement being taken in the consultation, and with a doctor who believed it possible to influence lifestyle change. Counseling for smoking was associated with younger patients, longer consultations, previous counseling, BP measurement, presenting with an associated condition, and not presenting frequently. CONCLUSIONS: We have identified factors associated with counseling about behavioral risk factors which provide a framework for planning education programs to increase the level of primary preventive activities within general practice.

Conducting regional health surveys using a computer-assisted telephone interviewing method.

After the creation of thirteen health regions within Queensland in 1991, the need arose for an information base at the regional level to assist regions with their role in planning, monitoring and evaluating health services. A series of regional health surveys was conducted in 1993 to provide this information, using a computer-assisted telephone interviewing method. Over 10 400 interviews were conducted throughout the state. This is the first time a computer-assisted method has been used on a large scale to collect health-related information in Australia. Interviews used list-directed or random-digit dialing, depending on the rate of unlisted numbers in a region. Response rates were not significantly different for the two methods, although the number of contactable numbers attempted and the noncontact rates were significantly higher for random-digit regions. The last-birthday method was used to select the adult for interview in each household. The method resulted in a bias toward female respondents.

Comparison of gender and victim response to violence in popular movies.

The overwhelming statistics of crime against women affect their perceptions and quality of life. The media have a significant effect on both perceptions and behavior. The manner, therefore, in which fictional victims are portrayed could affect perceptions of control in real-life women fearing victimization and in their potential assailants. Popular crime-drama movies and the difference between male and female behaviors were examined in this pilot study. A total of 65 responses were evaluated from a random sample of film videos. Active attempts to gain control were exhibited by 81% of the male responses, whereas only 17% of the women did so, chi 2 (1, N = 65) = 28.99, p less than .001. The relationship of results and myths concerning women as victims is discussed.

The variability of immunoglobulins and albumin in salivary secretions of children.

The variation of concentrations of immunoglobulins and albumin in consecutive daily collections of saliva was studied in 33 infants, aged 6 months to 5 years, for periods ranging from 16 to 26 days. The concentration and the within-child variability of IgA and albumin and the detection of IgG and IgM in saliva increased with age. Between-child variances were greater than the within-child variances by a factor of 2.8 for log (IgA) and 1.3 for log (albumin). The geometric mean IgA levels were consistently higher and IgG was detected more frequently during upper respiratory tract infections compared with periods of non-infection. There were no changes in albumin levels between infection and non-infection periods, suggesting a local immune response rather than serum leakage. There were significant within-child correlations (autocorrelations) between levels of IgA in saliva collected on consecutive days and samples collected up to 3 days apart. The autocorrelations between levels of albumin were significant for samples collected up to 2 days apart. The autocorrelation for IgA was significantly greater during infection periods compared with non-infection periods for samples collected on consecutive days.

Childhood deaths in Down's syndrome. Survival curves and causes of death from a total population study in Queensland, Australia, 1976 to 1985.

Data have been obtained from a total population study of diagnosed Down's syndrome cases born in Queensland between 1976 and 1985. Survival curves show a survival rate to one year of 87.4% and no significant differences in such patterns over the two five year periods of the study. Survival curves comparing maternal age at birth, sex of the infant, and locality of birth also indicate that early death is unrelated to any of these factors. Congenital heart disease and respiratory infection are the most common causes of infant death.

Breast feeding conditions a differential developmental pattern of mucosal immunity.

A prospective study of 146 children was conducted to evaluate the influence of infant feeding patterns on the development of mucosal immunity. First, there was a trend towards lower IgG concentrations in the breast-fed neonate, indicating a possible earlier 'closure' mechanism of membrane permeability. Second, the post-natal increase in IgA was earlier and greater in formula-fed infants. Third, IgM was detected earlier, more frequently, and at higher levels in formula-fed infants.

Patient satisfaction with primary-care consultations.

This study examines patients' perceptions of their latest consultation with a primary-care physician. A new questionnaire measured patients' views on their "ideal" physician prior to the visit and their satisfaction on similar dimensions immediately afterward. Ratings by the 503 eligible patients (87% response rate) showed that all 43 items were relevant and that a shortened version could also be used successfully. Patients held high expectations for, but were also quite satisfied with, their physicians' actual behavior during the consultation. Factor analysis of perceptions supported other research findings and raised some anomalies in relation to overordering of investigations and waiting time. Other analyses showed which characteristics of physicians and patients were most influential on satisfaction and which dimensions of care were common or distinct to the 22 physicians involved in this study.

Stereological analysis of non-Hodgkins lymphomas.

A detailed stereological analysis was carried out on 30 lymph nodes at 2 ultrastructural levels. They were classified as follows: 10 were reactive lymph nodes, 10 were of low-grade non-Hodgkins lymphomas and 10 were of high-grade non-Hodgkins lymphomas. The mean and median values and interquartile ranges of nuclear profile diameter, nuclear volume, volume of cytoplasm, cell volume and absolute number of ribosomes were recorded for each case. The model proved very efficient in establishing several significant differences between the highgrade and lowgrade lymphomas and between the highgrade lymphomas and reactive lymph nodes but did not discriminate between lowgrade lymphomas and reactive nodes, nor did it distinguish neoplastic cells from reactive cells in the neoplastic group. The significance of these findings is discussed.