Self-reported shift work, recall bias, and belief about disease causation in a case-control study of breast cancer.

BACKGROUND: Recall bias is a potential source of misclassification in case-control studies. Studies have shown that the association between exposure and disease can differ according to participants' beliefs or knowledge about the effect of that exposure on disease. We investigated the association between belief about breast cancer causation and self-reported shift work exposure in a case-control study. METHODS: Women completed a questionnaire asking whether they believed that shift work caused cancer either before or after reporting their history of shift work. We measured: whether belief modified the association between reported shift work and disease; whether belief was associated with reported shift work exposure; and whether being prompted to recall shift work exposure was associated with an increased likelihood of believing that shift work increased breast cancer risk. RESULTS: There was a significant association between believing shift work increased breast cancer risk and reporting exposure to shift work. Being prompted to recall shift work was not associated with a belief that shift work increased risk. CONCLUSION: The association between pre-existing belief about breast cancer risk and reported shift work is likely to be due to exposed individuals believing that exposure increases risk, rather than resulting from recall bias.

"Over time it just becomes easier ": parents of people with Angelman syndrome and Prader-Willi syndrome speak about their carer role.

PURPOSE: This study investigated two of the stresses experienced by parents caring for offspring with Angelman syndrome (AS) and Prader-Willi syndrome (PWS) in Western Australia, and identified their coping strategies. METHODS: Parents of 19 offspring with AS and PWS participated in the Family Stress and Coping Interview which provides a stress level score, and a discussion of stressors and coping methods associated with 24 life situations, two of which are reported. All text was examined using directed content analysis. RESULTS: Family carers (14/19) reported high stress associated with the initial diagnosis of AS or PWS in their offspring; and finding time for themselves. Stressors identified included lack of quality information about the disorder, time constraints and physical and emotional tiredness. Parents adopted a variety of coping strategies, including learning about the disorder, accepting the situation, seeking instrumental and social supports and dealing with problems. CONCLUSIONS: No specific coping strategy was associated with reduced stress. However, parents felt that accurate and timely information during the diagnostic period helped. Parents used family and community support although there were difficulties accessing respite care. It is advised that government agencies, service providers, family members and peer support associations should provide practical and emotional support to assist the parents of offspring with AS and PWS, and indeed any form of intellectual disability, across the lifespan. Implications for Rehabilitation Long-term caring for offspring with AS or PWS can involve considerable stress for parents. Stress has been associated with poorer health outcomes for parental carers. Parents need a variety of practical and emotional supports to cope with stress, including timely access to information.

Examples of individual supported living for adults with intellectual disability.

BACKGROUND: This article provides a qualitative account of four models of support for adults with intellectual disability in individual supported living (ISL) arrangements. MATERIALS AND METHODS: Completion of the first 50 evaluations of 150 arrangements for the third phase of the ISL project provided the examples. RESULTS: Four approaches are described: living alone, co-residency, relationship and host family. Within each type, wide variations occur particularly based on security of tenure, formal and informal support and management variations. CONCLUSION: Fifty evaluations so far illustrated a wide range of approaches to ISL, providing evidence of the critical importance of the formal and informal support environment and reinforcing the contention that ISL is appropriate for people with high support needs.

Women's beliefs about breast cancer causation in a breast cancer case-control study.

OBJECTIVE: Our study sought to ascertain women's beliefs about breast cancer risk factors and whether these beliefs differed by demographic factors and personal and family history of breast cancer. METHODS: Participants in a case-control study of breast cancer rated the effect of 37 exposures on the risk of being diagnosed with breast cancer. Chi-square tests were undertaken to measure differences in responses between cases and controls for each exposure. Logistic regression was undertaken to ascertain whether demographic factors and personal and family history of breast cancer affected participants' ability to correctly identify known breast cancer risk factors. RESULTS: A total of 2742 participants completed the questionnaire, comprising 1109 cases and 1633 controls. Significant differences (p < 0.05) between cases and controls were found for 16 of the 37 exposures. Younger women and university-educated women were more likely to correctly identify known breast cancer risk factors. Women's perceptions about the effect of alcohol consumption on breast cancer risk, particularly regarding red wine, differed from that reported in the literature. CONCLUSIONS: Beliefs about risk factors for breast cancer may differ between cases and controls. Public health initiatives aimed at increasing awareness of breast cancer risk factors should consider that women's beliefs may differ by demographic factors and family history of breast cancer.

Occupational exposure to solvents and risk of breast cancer.

BACKGROUND: Occupational exposure to some organic solvents may increase risk of breast cancer. METHODS: In a population-based case-control study, 1,205 women diagnosed with primary breast cancer between 2009 and 2011 were drawn from the Western Australian Cancer Registry and matched to 1,789 controls from the electoral roll. Exposure to solvents was determined through telephone interviews using OccIDEAS. RESULTS: About a third of women were occupationally exposed to solvents. Age adjusted breast cancer risks were elevated for women who had been exposed to aliphatic solvents odds ratio (OR) 1.21 (95%CI 0.99-1.48) and aromatic solvents OR 1.21 (95%CI 0.97-1.52). For most solvents the ORs were higher for those diagnosed before menopause. CONCLUSIONS: This study suggests that there may be an association between occupational exposure to aliphatic and aromatic solvents and the risk of breast cancer at the low levels of exposure experienced by women in this study.

Beliefs and perceptions about the causes of breast cancer: a case-control study.

BACKGROUND: Attributions of causality are common for many diseases, including breast cancer. The risk of developing breast cancer can be reduced by modifications to lifestyle and behaviours to minimise exposure to specific risk factors, such as obesity. However, these modifications will only occur if women believe that certain behaviours/lifestyle factors have an impact on the development of breast cancer. METHOD: The Breast Cancer, Environment and Employment Study is a case-control study of breast cancer conducted in Western Australia between 2009 and 2011. As part of the study 1109 women with breast cancer and 1633 women without the disease completed a Risk Perception Questionnaire in which they were asked in an open-ended question for specific cause/s to the development of breast cancer in themselves or in others. The study identified specific causal beliefs, and assessed differences in the beliefs between women with and without breast cancer. RESULTS: The most common attributions in women without breast cancer were to familial or inherited factors (77.6%), followed by lifestyle factors, such as poor diet and smoking (47.1%), and environmental factors, such as food additives (45.4%). The most common attributions in women with breast cancer were to mental or emotional factors (46.3%), especially stress, followed by lifestyle factors (38.6%) and physiological factors (37.5%), particularly relating to hormonal history. CONCLUSIONS: While the majority of participants in this study provided one or more causal attributions for breast cancer, many of the reported risk factors do not correspond to those generally accepted by the scientific community. These misperceptions could be having a significant impact on the success of prevention and early detection programs that seek to minimise the pain and suffering caused by this disease. In particular, women who have no family history of the disease may not work to minimise their exposure to the modifiable risk factors.

Occupational exposure to ionizing radiation and risk of breast cancer in Western Australia.

OBJECTIVE: To evaluate current breast cancer risk due to occupational exposure to ionizing radiation. METHODS: We analyzed data from the Western Australian population-based Breast Cancer Employment and Environment Study. The Breast Cancer Employment and Environment Study included 1205 cases with incident breast cancer during 2009-2011 and 1789 controls. Age-adjusted odds ratios (ORs) were estimated with logistic regression models. RESULTS: There was a weak, not statistically significant association between breast cancer and occupational exposure to ionizing radiation (OR = 1.16; 95% confidence interval, 0.86 to 1.57). The risk of human epidermal growth factor receptor 2-positive breast cancer with occupational exposure to ionizing radiation in women who were premenopausal at the time of interview was higher (OR = 2.57; 95% confidence interval, 1.09 to 6.03). CONCLUSIONS: This study suggests that the risk of breast cancer is low at current levels of occupational exposure to ionizing radiation, although the risk of human epidermal growth factor receptor 2-positive cancer may be a concern.

Including questionnaires with the invitation package appeared to increase the response fraction among women.

OBJECTIVE: The Breast Cancer Environment and Employment Study (BCEES) is a case--control study that began in 2009. The study experienced a lower than expected response fraction, a trend that appears to be occurring internationally. A 32-page questionnaire was included in the initial invitation to participate, and previous research suggests that long questionnaires decrease response fractions. The aim of this study was to test whether removal of the questionnaire from the invitation package increased participation. STUDY DESIGN AND SETTING: A randomized controlled trial was undertaken among the BCEES controls from June to August 2010. One group of 250 received the questionnaire in the initial invitation package, and the other group of 250 received only the invitation package and was sent the questionnaire after their consent was received. The proportion of responses for the two groups was compared using contingency tables and chi-square statistics. RESULTS: Those who received the questionnaire with the invitation package were more likely to consent to participate than those who did not (40.8% and 33.2%, respectively). However, this difference was not statistically significant (P=0.078). CONCLUSION: To improve response fractions and reduce time in following up nonresponses, questionnaires should be included in the invitation package.

Triaging jobs in a community-based case-control study to increase efficiency of the expert occupational assessment method.

OBJECTIVES: Expert assessment is useful to assess occupational exposures in cases where measured exposure data are not available. However, the process may be inefficient in a community-based study with low prevalence of exposure. This study aimed to determine if formally triaging the jobs as to likelihood of exposure before the experts review those jobs could improve study efficiency. METHODS: One thousand nine hundred and sixty-one jobs from a case-control study were triaged by study staff (non-occupational health professionals) into four groups depending on the likelihood of exposure to solvents. For jobs in one group, we had additional information available in the form of job-specific modules and automatic exposure assignments for solvents based on rules pre-programmed into the job-specific module. After the automatic assignment, two experts reviewed the jobs to assign exposure to solvents in order to evaluate the process. The prevalence of exposure and the agreement between the two raters and between the raters' and the automatic assignments were compared for the four triage groups. RESULTS: The majority of jobs (76%) were triaged as unexposed by study staff and very few of these jobs were assigned as exposed by the raters (1%). For jobs with automatic assignment (18% of total), the raters tended to agree with the automatic assignment if that assignment was unexposed or probably exposed. There was less agreement for jobs in which the automatic assignment was possible exposure. For jobs triaged as ones with potential exposure based only on job title but with no further information available, the level of disagreement between the raters tended to be higher. CONCLUSIONS: Formal triaging of jobs can improve the efficiency of the expert assessment process. Of the 75% of jobs initially triaged as unexposed, virtually no exposures were found, and omitting manual review of this group would save considerable time.