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.

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.

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.

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.

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.

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.