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Merrick S, Nankivell M, Quartagno M, Clarke CS, Joharatnam-Hogan N, Waddell T, O'Carrigan B, Seckl M, Ghorani E, Banks E, Edmonds K, Bray G, Woodward R, Bennett R, Badrock J, Hudson W, Langley RE, Vasudev N, Pickering L, Gilbert DC. REFINE (REduced Frequency ImmuNE checkpoint inhibition in cancers): A multi-arm phase II basket trial testing reduced intensity immunotherapy across different cancers. Contemp Clin Trials 2023; 124:107030. [PMID: 36519749 PMCID: PMC7614585 DOI: 10.1016/j.cct.2022.107030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have revolutionised treating advanced cancers. ICI are administered intravenously every 2-6 weeks for up to 2 years, until cancer progression/unacceptable toxicity. Physiological efficacy is observed at lower doses than those used as standard of care (SOC). Pharmacodynamic studies indicate sustained target occupancy, despite a pharmacological half-life of 2-3 weeks. Reducing frequency of administration may be possible without compromising outcomes. The REFINE trial aims to limit individual patient exposure to ICI whilst maintaining efficacy, with potential benefits in quality of life and reduced drug treatment/attendance costs. METHODS/DESIGN REFINE is a randomised phase II, multi-arm, multi-stage (MAMS) adaptive basket trial investigating extended interval administration of ICIs. Eligible patients are those responding to conventionally dosed ICI at 12 weeks. In stage I, patients (n = 160 per tumour-specific cohort) will be randomly allocated (1:1) to receive maintenance ICI at SOC vs extended dose interval. REFINE is currently recruiting UK patients with locally advanced or metastatic renal cell carcinoma (RCC) who have tolerated and responded to initial nivolumab/ipilimumab, randomised to receive maintenance nivolumab SOC (480 mg 4 weekly) vs extended interval (480 mg 8 weekly). Additional tumour cohorts are planned. Subject to satisfactory outcomes (progression-free survival) stage II will investigate up to 5 different treatment intervals. Secondary outcome measures include overall survival, quality-of-life, treatment-related toxicity, mean incremental pathway costs and quality-adjusted life-years per patient. REFINE is funded by the Jon Moulton Charity Trust and Medical Research Council, sponsored by University College London (UCL), and coordinated by the MRC CTU at UCL. Trial Registration ISRCTN79455488. NCT04913025 EUDRACT #: 2021-002060-47. CTA 31330/0008/001-0001; MREC approval: 21/LO/0593. REFINE Protocol version 4.0.
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Affiliation(s)
- Sophie Merrick
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Matthew Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Matteo Quartagno
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Caroline S Clarke
- University College London (UCL) Research Department of Primary Care and Population Health, Upper 3rd Floor, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
| | - Nalinie Joharatnam-Hogan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Tom Waddell
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Brent O'Carrigan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus Hill's Road, Cambridge CB2 0QQ, UK
| | - Michael Seckl
- Imperial College London, Division of Cancer, 2nd floor U201 Hammersmith Hospital Campus, London W12 0NN, UK
| | - Ehsan Ghorani
- Imperial College London, Division of Cancer, 2nd floor U201 Hammersmith Hospital Campus, London W12 0NN, UK
| | - Emma Banks
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Kim Edmonds
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - George Bray
- University College London (UCL) Research Department of Primary Care and Population Health, Upper 3rd Floor, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
| | - Rose Woodward
- Action Kidney Cancer, 11th Floor, 3 Piccadilly Place, Manchester M1 3BN, UK
| | - Rachel Bennett
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Jonathan Badrock
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Will Hudson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Naveen Vasudev
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Lisa Pickering
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK.
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Laidsaar-Powell R, Butow P, Brown B, Mander K, Young J, Stone E, Chin V, Banks E, Lim C, Rankin N. EP10.01-005 Australian Lung Cancer Survivors Experiences of Novel Treatments, Healthcare, and Ongoing Physical and Psychological Needs. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Banks E. The Frontier Effect: State Formation and Violence in Colombia. TeoBallvé. Ithaca, NY: Cornell University Press, 2020. 228 pp. J Latin Amer Carib Anth 2021. [DOI: 10.1111/jlca.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Welsh J, Bishop K, Booth H, Butler D, Gourley M, Law HD, Banks E, Canudas-Romo V, Korda RJ. Inequalities in life expectancy in Australia according to education level: a whole-of-population record linkage study. Int J Equity Health 2021; 20:178. [PMID: 34344367 PMCID: PMC8330008 DOI: 10.1186/s12939-021-01513-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Life expectancy in Australia is amongst the highest globally, but national estimates mask within-country inequalities. To monitor socioeconomic inequalities in health, many high-income countries routinely report life expectancy by education level. However in Australia, education-related gaps in life expectancy are not routinely reported because, until recently, the data required to produce these estimates have not been available. Using newly linked, whole-of-population data, we estimated education-related inequalities in adult life expectancy in Australia. Methods Using data from 2016 Australian Census linked to 2016-17 Death Registrations, we estimated age-sex-education-specific mortality rates and used standard life table methodology to calculate life expectancy. For men and women separately, we estimated absolute (in years) and relative (ratios) differences in life expectancy at ages 25, 45, 65 and 85 years according to education level (measured in five categories, from university qualification [highest] to no formal qualifications [lowest]). Results Data came from 14,565,910 Australian residents aged 25 years and older. At each age, those with lower levels of education had lower life expectancies. For men, the gap (highest vs. lowest level of education) was 9.1 (95 %CI: 8.8, 9.4) years at age 25, 7.3 (7.1, 7.5) years at age 45, 4.9 (4.7, 5.1) years at age 65 and 1.9 (1.8, 2.1) years at age 85. For women, the gap was 5.5 (5.1, 5.9) years at age 25, 4.7 (4.4, 5.0) years at age 45, 3.3 (3.1, 3.5) years at 65 and 1.6 (1.4, 1.8) years at age 85. Relative differences (comparing highest education level with each of the other levels) were larger for men than women and increased with age, but overall, revealed a 10–25 % reduction in life expectancy for those with the lowest compared to the highest education level. Conclusions Education-related inequalities in life expectancy from age 25 years in Australia are substantial, particularly for men. Those with the lowest education level have a life expectancy equivalent to the national average 15–20 years ago. These vast gaps indicate large potential for further gains in life expectancy at the national level and continuing opportunities to improve health equity. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01513-3.
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Affiliation(s)
- J Welsh
- Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia.
| | - K Bishop
- Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia
| | - H Booth
- School of Demography, Australian National University, Acton, Australia
| | - D Butler
- Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia
| | - M Gourley
- Australian Institute of Health and Welfare, Canberra, Australia
| | - H D Law
- Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia
| | - E Banks
- Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia
| | - V Canudas-Romo
- School of Demography, Australian National University, Acton, Australia
| | - R J Korda
- Research School of Population Health, Australian National University, Building 62, Mills Rd, ACT, 2601, Acton, Australia
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Lokuge K, Banks E, Davis S, Roberts L, Street T, O'Donovan D, Caleo G, Glass K. Exit strategies: optimising feasible surveillance for detection, elimination, and ongoing prevention of COVID-19 community transmission. BMC Med 2021; 19:50. [PMID: 33596902 PMCID: PMC7887417 DOI: 10.1186/s12916-021-01934-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Following implementation of strong containment measures, several countries and regions have low detectable community transmission of COVID-19. We developed an efficient, rapid, and scalable surveillance strategy to detect remaining COVID-19 community cases through exhaustive identification of every active transmission chain. We identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not require reinstatement. METHODS We compared efficiency and sensitivity to detect community transmission chains through testing of the following: hospital cases; fever, cough and/or ARI testing at community/primary care; and asymptomatic testing; using surveillance evaluation methods and mathematical modelling, varying testing capacities, reproductive number (R) and weekly cumulative incidence of COVID-19 and non-COVID-19 respiratory symptoms using data from Australia. We assessed system requirements to identify all transmission chains and follow up all cases and primary contacts within each chain, per million population. RESULTS Assuming 20% of cases are asymptomatic and 30% of symptomatic COVID-19 cases present for testing, with R = 2.2, a median of 14 unrecognised community cases (8 infectious) occur when a transmission chain is identified through hospital surveillance versus 7 unrecognised cases (4 infectious) through community-based surveillance. The 7 unrecognised community upstream cases are estimated to generate a further 55-77 primary contacts requiring follow-up. The unrecognised community cases rise to 10 if 50% of cases are asymptomatic. Screening asymptomatic community members cannot exhaustively identify all cases under any of the scenarios assessed. The most important determinant of testing requirements for symptomatic screening is levels of non-COVID-19 respiratory illness. If 4% of the community have respiratory symptoms, and 1% of those with symptoms have COVID-19, exhaustive symptomatic screening requires approximately 11,600 tests/million population using 1/4 pooling, with 98% of cases detected (2% missed), given 99.9% sensitivity. Even with a drop in sensitivity to 70%, pooling was more effective at detecting cases than individual testing under all scenarios examined. CONCLUSIONS Screening all acute respiratory disease in the community, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of COVID-19 community transmission. An important component is identification, testing, and management of all contacts, including upstream contacts (i.e. potential sources of infection for identified cases, and their related transmission chains). Pooling allows increased case detection when testing capacity is limited, even given reduced test sensitivity. Critical to the effectiveness of all aspects of surveillance is appropriate community engagement, messaging to optimise testing uptake and compliance with other measures.
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Affiliation(s)
- K Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia.
| | - E Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - S Davis
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - L Roberts
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - T Street
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - D O'Donovan
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - G Caleo
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - K Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
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6
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Lokuge K, Banks E, Davis S, Roberts L, Street T, O'Donovan D, Caleo G, Glass K. Exit strategies: optimising feasible surveillance for detection, elimination, and ongoing prevention of COVID-19 community transmission. BMC Med 2021; 19:50. [PMID: 33596902 DOI: 10.1101/2020.04.19.20071217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 02/02/2021] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Following implementation of strong containment measures, several countries and regions have low detectable community transmission of COVID-19. We developed an efficient, rapid, and scalable surveillance strategy to detect remaining COVID-19 community cases through exhaustive identification of every active transmission chain. We identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not require reinstatement. METHODS We compared efficiency and sensitivity to detect community transmission chains through testing of the following: hospital cases; fever, cough and/or ARI testing at community/primary care; and asymptomatic testing; using surveillance evaluation methods and mathematical modelling, varying testing capacities, reproductive number (R) and weekly cumulative incidence of COVID-19 and non-COVID-19 respiratory symptoms using data from Australia. We assessed system requirements to identify all transmission chains and follow up all cases and primary contacts within each chain, per million population. RESULTS Assuming 20% of cases are asymptomatic and 30% of symptomatic COVID-19 cases present for testing, with R = 2.2, a median of 14 unrecognised community cases (8 infectious) occur when a transmission chain is identified through hospital surveillance versus 7 unrecognised cases (4 infectious) through community-based surveillance. The 7 unrecognised community upstream cases are estimated to generate a further 55-77 primary contacts requiring follow-up. The unrecognised community cases rise to 10 if 50% of cases are asymptomatic. Screening asymptomatic community members cannot exhaustively identify all cases under any of the scenarios assessed. The most important determinant of testing requirements for symptomatic screening is levels of non-COVID-19 respiratory illness. If 4% of the community have respiratory symptoms, and 1% of those with symptoms have COVID-19, exhaustive symptomatic screening requires approximately 11,600 tests/million population using 1/4 pooling, with 98% of cases detected (2% missed), given 99.9% sensitivity. Even with a drop in sensitivity to 70%, pooling was more effective at detecting cases than individual testing under all scenarios examined. CONCLUSIONS Screening all acute respiratory disease in the community, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of COVID-19 community transmission. An important component is identification, testing, and management of all contacts, including upstream contacts (i.e. potential sources of infection for identified cases, and their related transmission chains). Pooling allows increased case detection when testing capacity is limited, even given reduced test sensitivity. Critical to the effectiveness of all aspects of surveillance is appropriate community engagement, messaging to optimise testing uptake and compliance with other measures.
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Affiliation(s)
- K Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia.
| | - E Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - S Davis
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - L Roberts
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - T Street
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - D O'Donovan
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - G Caleo
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
| | - K Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, ACT, 2601, Acton, Australia
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Qian J, Banks E, Macartney K, Haywood A, Liu B. Effect of systemic corticosteroid use on risk of herpes zoster in a population-based cohort study. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cavers D, Cunningham-Burley S, Watson E, Banks E, Campbell C. Setting the research agenda for living with and beyond cancer with comorbid illness: reflections on a research prioritisation exercise. Res Involv Engagem 2020; 6:17. [PMID: 32368351 PMCID: PMC7191759 DOI: 10.1186/s40900-020-00191-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND People living with and beyond cancer are more likely to have comorbid conditions and poorer mental and physical health, but there is a dearth of in-depth research exploring the psychosocial needs of people experiencing cancer and comorbid chronic conditions. A patient partnership approach to research prioritisation and planning can ensure outcomes meaningful to those affected and can inform policy and practice accordingly, but can be challenging. METHODS We aimed to inform priorities for qualitative inquiry into the experiences and support needs of people living with and beyond cancer with comorbid illness using a partnership approach. A three-step process including a patient workshop to develop a consultation document, online consultation with patients, and academic expert consultation was carried out. The research prioritisation process was also appraised and reflected upon. RESULTS Six people attended the workshop, ten responded online and eight academic experts commented on the consultation document. Five key priorities were identified for exploration in subsequent qualitative studies, including the diagnostic journey, the burden of symptoms, managing medications, addressing the needs of informal carers, and service provision. Limitations of patient involvement and reflections on procedural ethics, and the challenge of making measurable differences to patient outcomes were discussed. CONCLUSIONS Findings from this research prioritisation exercise will inform planned qualitative work to explore patients' experiences of living with and beyond cancer with comorbid illness. Including patient partners in the research prioritisation process adds focus and relevance, and feeds into future work and recommendations to improve health and social care for this group of patients. Reflections on the consultation process contribute to a broadening of understanding the field of patient involvement.
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Affiliation(s)
- D. Cavers
- Usher Institute, University of Edinburgh, Medical School, Rm 123, Doorway 1, Teviot Place, Edinburgh, EH8 9AG UK
| | - S. Cunningham-Burley
- Usher Institute, University of Edinburgh, Medical School, Rm 123, Doorway 1, Teviot Place, Edinburgh, EH8 9AG UK
| | - E. Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, OX3 0FL UK
| | - E. Banks
- c/o NCRI, 2 Redman Place, Stratford, London, E20 1JQ UK
| | - C. Campbell
- Usher Institute, University of Edinburgh, Medical School, Rm 123, Doorway 1, Teviot Place, Edinburgh, EH8 9AG UK
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Welsh J, Korda RJ, Banks E, Strazdins L, Joshy G, Butterworth P. Identifying long-term psychological distress from single measures: evidence from a nationally representative longitudinal survey of the Australian population. BMC Med Res Methodol 2020; 20:55. [PMID: 32138694 PMCID: PMC7059354 DOI: 10.1186/s12874-020-00938-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single time-point assessments of psychological distress are often used to indicate chronic mental health problems, but the validity of this approach is unclear. The aims of this study were to investigate how a single assessment of distress relates to longer-term assessment and quantify misclassification from using single measures to indicate chronic distress. METHODS Data came from the Household, Income and Labour Dynamics in Australia Survey, a nationally representative study of Australian adults. Psychological distress, measured with the Kessler10 and categorised into low (scores:10- < 12), mild (12- < 16), moderate (16- < 22) and high (22-50), has been assessed in the Survey biennially since wave 7. Among respondents who were aged ≥25 years and participated in all waves in which distress was measured, we describe agreement in distress categories, and using a mixed linear model adjusting for age and sex we estimate change in scores, over a two-, four-, six- and eight-year follow-up period. We applied weights, benchmarked to the Australian population, to all analyses. RESULTS Two-years following initial assessment, proportions within identical categories of distress were 66.0% for low, 54.5% for mild, 44.0% for moderate and 50.3% for high, while 94.1% of those with low distress initially had low/mild distress and 81.4% with high distress initially had moderate/high distress. These patterns did not change materially as follow-up time increased. Over the full eight-year period, 77.3% of individuals with high distress initially reported high distress on ≥1 follow-up occasion. Age-and sex- adjusted change in K10 scores over a two-year period was 1.1, 0.5, - 0.7 and - 4.9 for low, mild, moderate and high distress, respectively, and also did not change materially as follow-up time increased. CONCLUSION In the absence of repeated measures, single assessments are useful proxies for chronic distress. Our estimates could be used in bias analyses to quantify the magnitude of the bias resulting from use of single assessments to indicate chronic distress.
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Affiliation(s)
- J Welsh
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia.
| | - R J Korda
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia
| | - E Banks
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia.,The Sax Institute, Ultimo, Australia
| | - L Strazdins
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia
| | - G Joshy
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia
| | - P Butterworth
- Research School of Population Health, Australian National University, Building 62, Mills Rd, Acton, ACT, 2601, Australia.,Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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10
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Banks E, Woodland MB. 2644 CREOG 2019 Resident Survey: Obgyn Perception of Surgical Confidence and Competence. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Laaksonen M, Arriaga M, Canfell K, MacInnis R, Hull P, Banks E, Giles G, Mitchell P, Cumming R, Byles J, Magliano D, Shaw J, Taylor A, Gill T, Hirani V, Marker J, McCullough S, Velentzis L, Adelstein BA, Vajdic C. Future Burden of Cancer Attributable to Current Modifiable Behaviours: A Pooled Study of Seven Australian Cohorts. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.18500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Population Attributable Fraction (PAF) quantifies the fraction of cancer cases attributable to specific exposures. PAF estimates for the future burden of cancer preventable through modifications to current exposure distributions are lacking. Previous PAF studies have also not compared population subgroup differences. Aim: To apply a novel PAF method and i) assess the future burden of cancer in Australia preventable through modifications to current behaviors, and ii) compare the distribution of the preventable cancer burden between population subgroups. Methods: We harmonized and pooled data from seven Australian cohort studies (N=367058) and linked them to national registries to identify cancers and deaths. We estimated the strength of the associations between behaviors and cancer incidence and death using a proportional hazards model, adjusting for age, sex, study and other risk factors. Exposure prevalence was estimated from contemporary national health surveys. We then combined these estimates to calculate PAFs and their 95% confidence intervals for both individual and joint behavior modifications using a novel method accounting for competing risk of death and risk factor interdependence. We also compared PAFs between population subgroups by calculating the 95% confidence interval of the difference in PAF estimates. Results: During the first 10 years of follow-up, there were 22078 deaths and 27483 incident cancers, including 2025 lung, 3471 colorectal, 640 premenopausal and 2632 postmenopausal breast cancers. The leading preventable cause for lung cancer is current smoking (PAF = 53.7%), for colorectal and postmenopausal breast cancer body fatness or BMI ≥ 25 kg/m2 (PAF = 11.1% and 10.9% respectively), and for premenopausal breast cancer regular alcohol intake (PAF = 12.3%). Three in five lung cancers, but only one in five colorectal and breast cancers, are jointly attributable to potentially modifiable exposures, which also included physical inactivity and inadequate fruit intake for lung, excessive alcohol intake and current smoking for colorectal, regular alcohol intake and current menopausal hormone therapy for 1 year or more for postmenopausal breast and current oral contraceptive use for 5 years or more for premenopausal breast cancer. The cancer burden attributable to modifiable factors is markedly higher in certain population subgroups, including men (lung, colorectal), people with risk factor clustering (lung, colorectal, breast), and individuals with low educational attainment (lung, breast). Conclusion: We provided up-to-date estimates of the future Australian cancer burden attributable to modifiable risk factors, and identified population subgroups that experience the highest preventable burden. Application of the novel PAF method can inform timely public health action to improve health and health equity, by identifying those with the most to gain from programs that support behavior change and early detection.
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Affiliation(s)
| | - M.E. Arriaga
- University of New South Wales, Sydney, Australia
| | | | | | - P. Hull
- University of New South Wales, Sydney, Australia
| | - E. Banks
- Australian National University, Canberra, Australia
| | - G.G. Giles
- Cancer Council Victoria, Melbourne, Australia
| | | | | | - J.E. Byles
- University of Newcastle, Newcastle, Australia
| | - D.J. Magliano
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J.E. Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - T.K. Gill
- University of Adelaide, Adelaide, Australia
| | - V. Hirani
- University of Sydney, Sydney, Australia
| | - J. Marker
- Cancer Voices South Australia, Adelaide, Australia
| | | | | | | | - C.M. Vajdic
- University of New South Wales, Sydney, Australia
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Cavers D, Habets L, Cunningham-Burley S, Watson E, Banks E, Campbell C. The Experience of Living With and Beyond Cancer With Comorbid Illness: A Qualitative Systematic Review. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.57900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There is a need to explore the needs of the growing number of people living with and beyond cancer with additional long term chronic conditions, with implications for cancer survivorship management and support. Aim: This review aims to identify the qualitative evidence on the experience of cancer and comorbid illness from the perspective of patients, carers and health care professionals to identify psycho-social support needs, experience of health care, and to highlight areas where more research is needed. Methods: PRISMA guidance was used to review the evidence. Relevant research databases were searched using an exhaustive list of search terms. Two reviewers independently screened titles and abstracts and discussed variations. Included articles were subject to quality appraisal before data extraction of article characteristics and findings. Thematic synthesis of extracted findings was undertaken following Thomas and Harden's prescribed method. Results: 29 articles were included in the review covering a range of cancer types and comorbid conditions; with varying time since cancer diagnosis and apparent severity of disease for both cancer and other conditions. Studies are set in developed countries and include the views of patients and professionals but not carers. Few studies focused exclusively on the experience of living with comorbid conditions alongside cancer. Key themes identified included: the interaction between cancer and comorbid conditions; the added symptom burden; illness identities and ageing; self-management; prioritizing conditions, and treatment decision-making. Conclusion: In addition to a better understanding of the complex experience of such illness to illuminate developing models of patient-centered care, the review will combine with patient engagement work to inform an interview study with the defined patient group.
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Affiliation(s)
- D. Cavers
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - L. Habets
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - E. Watson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - E. Banks
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - C. Campbell
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Paige E, Welsh J, Agostino J, Calabria B, Banks E, Korda R. Socioeconomics differences in absolute cardiovascular disease risk and treatment: Opportunities for reducing inequalities in cardiovascular events in the population. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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14
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Jorgensen E, DeStephano C, Haviland M, Banks E, Hur HC. ACOG Simulation Working Group Assessment of Simulation Needs in Ob/Gyn Training Programs. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Background The use of hormone replacement therapy (HRT) is prevalent in the age group invited to routine breast cancer screening in many countries. Previous publications have reported reduced sensitivity and specificity of mammographic breast cancer screening associated with current use of HRT. Objectives To review the epidemiological evidence for the relation between use of HRT and the risk of having breast cancer diagnosed between screens (interval breast cancer—sensitivity) and being recalled for assessment after initial mammography with no diagnosis of breast cancer at that screen (false positive recall—specificity). Methods Overview of published literature. Results Eight studies were identified, providing a total of 367 interval cancers and 8878 cases of false positive recall, in women of 50 and over. Overall, the studies showed an increased risk of interval cancer and false positive recall in current users of HRT compared with non-users. Only one study accounted for the essential confounding factors of age and menopause. Furthermore, information on duration and recency of HRT use was not available for most studies. Conclusions Studies to date indicate that women using HRT are more likely to experience reduced sensitivity and specificity of breast cancer screening, compared with women not using HRT. However, because results have not been adjusted for crucial confounding factors, the magnitude of these effects is uncertain.
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Affiliation(s)
- E Banks
- Imperial Cancer Research Fund, Cancer Epidemiology Unit, University of Oxford, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK.
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Pedisic Z, Grunseit A, Ding D, Chau J, Banks E, Stamatakis E, Jalaludin B, Bauman A. Association between sedentary behaviour and weight gain: A longitudinal study of middle-aged adults in New South Wales, Australia. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Charlton K, Kowal P, Soriano M, Williams S, Banks E, Vo K, Byles J. Fruit and vegetable intake and body mass index in a large sample of middle-aged Australian men and women. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
OBJECTIVES To investigate how results of the association between education and weight change vary when weight change is defined and modelled in different ways. DESIGN Longitudinal cohort study. PARTICIPANTS 60 404 men and women participating in the Social, Environmental and Economic Factors (SEEF) subcomponent of the 45 and Up Study-a population-based cohort study of people aged 45 years or older, residing in New South Wales, Australia. OUTCOME MEASURES The main exposure was self-reported education, categorised into four groups. The outcome was annual weight change, based on change in self-reported weight between the 45 and Up Study baseline questionnaire and SEEF questionnaire (completed an average of 3.3 years later). Weight change was modelled in four different ways: absolute change (kg) modelled as (1) a continuous variable and (2) a categorical variable (loss, maintenance and gain), and relative (%) change modelled as (3) a continuous variable and (4) a categorical variable. Different cut-points for defining weight-change categories were also tested. RESULTS When weight change was measured categorically, people with higher levels of education (compared with no school certificate) were less likely to lose or to gain weight. When weight change was measured as the average of a continuous measure, a null relationship between education and annual weight change was observed. No material differences in the education and weight-change relationship were found when comparing weight change defined as an absolute (kg) versus a relative (%) measure. Results of the logistic regression were sensitive to different cut-points for defining weight-change categories. CONCLUSIONS Using average weight change can obscure important directional relationship information and, where possible, categorical outcome measurements should be included in analyses.
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Affiliation(s)
- E Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - R J Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - E Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - B Rodgers
- Australian Demographic & Social Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia
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Lokuge K, Shah T, Pintaldi G, Thurber K, Martínez-Viciana C, Cristobal M, Palacios L, Dear K, Banks E. Mental health services for children exposed to armed conflict: Médecins Sans Frontières' experience in the Democratic Republic of Congo, Iraq and the occupied Palestinian territory. Paediatr Int Child Health 2013; 33:259-72. [PMID: 24196701 PMCID: PMC3817578 DOI: 10.1179/2046905513y.0000000098] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Armed conflict has broad-ranging impacts on the mental health and wellbeing of children and adolescents. Mental health needs greatly exceed service provision in conflict settings, particularly for these age groups. The provision and targeting of appropriate services requires better understanding of the characteristics and requirements of children and adolescents exposed to armed conflict. METHODS Routine patient and programme monitoring data were analysed for patients <20 years of age attending mental health services provided by Médecins Sans Frontières (MSF) in three countries affected by armed conflict: the Democratic Republic of Congo (DRC), Iraq and the occupied Palestinian territory (oPt). The demographic characteristics, presenting mental health complaint, attributed precipitating event, services provided and short-term outcomes for mental health services users in each country are described. RESULTS Between 2009 and 2012, 3025 individuals <20 years of age presented for care in DRC and Iraq, and in 2012 in oPt, constituting 14%, 17.5% and 51%, respectively, of all presentations to MSF mental health services in those three countries. The most common precipitating event was sexual violence in DRC (36.5%), domestic violence in Iraq (17.8%) and incarceration or detention in oPt (33%). Armed conflict-related precipitants were reported by 25.9%, 55.0% and 76.4% of youths in DRC, Iraq and oPt, respectively. The most common presenting complaints in children and adolescents were anxiety-related, followed by mood-related, behaviour-related and somatisation problems; these varied according to country and precipitating event. Although a high proportion (45.7%) left programmes early, 97% of those who completed care self-reported improvement in their presenting complaint. CONCLUSIONS Brief trauma-focused therapy, the current MSF mental health therapeutic intervention, appears to be effective in reducing symptoms arising from the experience of trauma. Although inferences on outcomes are limited by high default rates, this provides a feasible tool for addressing the mental health needs of children exposed to armed conflict. Priorities for future research include understanding why children and adolescents constitute a small proportion of patients in some programmes, why many leave care early and how to address these issues, but this research must occur within the context of efforts to provide access to mental health services for children.
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Affiliation(s)
- K Lokuge
- The Australian National University, Canberra, ACT, 0200, Australia,MSF-UK, London
| | | | - G Pintaldi
- MSF-Operational Centre, Amsterdam, The Netherlands
| | - K Thurber
- The Australian National University, Canberra, ACT, 0200, Australia
| | | | | | - L Palacios
- MSF-Operational Centre, Barcelona, Spain
| | - K Dear
- The Australian National University, Canberra, ACT, 0200, Australia
| | - E Banks
- The Australian National University, Canberra, ACT, 0200, Australia
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Banks E, Harris M, Garza-Leal J, Robles Pemueller R, Chudnoff S, Abbott K, Berman J. Prospective 12-Month Follow-Up of Menstrual Blood Loss Reduction Following 135 Consecutive Cases of Radiofrequency Volumetric Thermal Ablation of Symptomatic Fibroids. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Harris M, Banks E, Garza-Leal J, Robles Pemueller R, Abbott K, Berman J. Relationship between Menstrual Blood Loss and Fibroid Volume and Size Pre- and Post Radiofrequency Volumetric Thermal Ablation (RFVTA). J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Lucas RM, Lai JKC, Banks E, Ponsonby AL. Reply. Intern Med J 2012. [DOI: 10.1111/j.1445-5994.2012.02859.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Banks E. John Stuart Gregory. Assoc Med J 2012. [DOI: 10.1136/bmj.e4052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gillis VL, Senthinathan A, Dzingina M, Chamberlain K, Banks E, Baker MR, Longson D. Management of an acute painful sickle cell episode in hospital: summary of NICE guidance. BMJ 2012; 344:e4063. [PMID: 22740566 DOI: 10.1136/bmj.e4063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- V L Gillis
- National Institute for Health and Clinical Excellence, Manchester M1 4BD, UK
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Robles Pemueller R, Garza Leal J, Banks E, Chudnoff S, Falls J, Guido R, Tilley I. One Hundred Ninety Cases of Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation of Fibroids: Discharge and Recovery Times. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Korda R, Banks E, Clements M, Bauman A, Liu B, Bambrick H, Jorm L. P2-145 BMI and the risk of hospitalisation. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976i.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Williams Z, Veeck L, Banks E, Neri Q, Palermo G, Rosenwaks Z. A mathematical model to predict pregnancy and delivery rates of singletons, twins and higher order multiples in women undergoing in vitro fertilization. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zhou JL, Zhang ZL, Banks E, Grover D, Jiang JQ. Pharmaceutical residues in wastewater treatment works effluents and their impact on receiving river water. J Hazard Mater 2009; 166:655-661. [PMID: 19121894 DOI: 10.1016/j.jhazmat.2008.11.070] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Revised: 11/24/2008] [Accepted: 11/24/2008] [Indexed: 05/25/2023]
Abstract
Various pharmaceutical residues are being discharged from wastewater treatment works (WTW) effluents, the impact of which on river water quality is of high relevance to environmental risk assessment. The concentrations of eleven pharmaceutical compounds were determined in three WTWs in England, and the river Ouse receiving effluents from Scaynes Hill WTW. Results show that five compounds propranolol, sulfamethoxazole, carbamazepine, indomethacin and diclofenac were detected in all wastewater and river water samples, with carbamazepine showing the highest concentrations (up to 2336 ng L(-1)) in WTW influent. Different compounds were removed to different extent in the WTWs, varying from 43 to 92%, with the highest performance obtained by the WTW with tertiary treatment (sand filtration). The pharmaceutical residues from Scaynes Hill WTW were eventually discharged into the river Ouse, causing an elevation in their concentrations downstream of the outfall. This was confirmed by the good agreement between measured concentrations and those predicted by a simple dilution model.
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Affiliation(s)
- J L Zhou
- Department of Biology and Environmental Science, School of Life Sciences, University of Sussex, Falmer, Brighton BN1 9QG, UK.
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Lawrence M, Jones L, Lancaster T, Daly E, Banks E. Hormone replacement therapy: patterns of use studied through British general practice computerized records. Climacteric 2009. [DOI: 10.3109/13697139909038096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liu B, Balkwill A, Banks E, Cooper C, Green J, Beral V. Relationship of height, weight and body mass index to the risk of hip and knee replacements in middle-aged women. Rheumatology (Oxford) 2007; 46:861-7. [PMID: 17282995 DOI: 10.1093/rheumatology/kel434] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To examine the effect of height, weight and body mass index (BMI) on the risk of hip and knee replacement in middle-aged women. METHODS In a prospective cohort study 490 532 women aged 50-69 yrs who were recruited in the UK in 1996-2001 were followed over 2.9 yrs for incident primary hip and knee replacements. RESULTS Height, weight and BMI were all associated with the risk of hip and knee replacement. Comparing the tallest group (>or=170 cm) with the shortest (<155 cm) the relative risks were 1.90 (95%CI 1.55-2.32) for hip replacement and 1.55 (95%CI 1.19-2.00) for knee replacement. Comparing the heaviest group (>or=75 kg) with the lightest (<60 kg) the relative risks of hip and knee replacement were 2.37 (95%CI 2.04-2.75) and 9.71 (95%CI 7.39-12.77), respectively. Comparing obese women (BMI >or= 30 kg/m(2)) to women with a BMI < 22.5 kg/m(2), the relative risks for hip and knee replacement were 2.47 (95%CI 2.11-2.89) and 10.51 (95%CI 7.85-14.08), respectively. These effects did not vary according to age, education, alcohol and tobacco consumption, or with use of hormonal therapies. Currently, an estimated 27% of hip replacements and 69% of knee replacements in middle-aged women in the UK are attributable to obesity. CONCLUSION In middle-aged women, the risk of having a hip or knee replacement increases with both increasing height and increasing BMI. From a clinical perspective, relatively small increases in average BMI among middle-aged women are likely to have a substantial impact on the already increasing rates of joint replacement in the UK.
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Affiliation(s)
- B Liu
- Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK.
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Banks E, Beral V, Reeves G. Published results on breast cancer and hormone replacement therapy in the Million Women Study are correct. Climacteric 2005; 7:415-6; author reply 416-7. [PMID: 15799614 DOI: 10.1080/13697130400014698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Banks E, Barnes I, Baker K, Key TJ. Use of hormonal therapy for menopause in nine European countries. IARC Sci Publ 2003; 156:301-3. [PMID: 12484192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- E Banks
- Imperial Cancer Research Fund, Cancer Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK
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Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M. Predictors of outcome of mammography in the National Health Service Breast Screening Programme. J Med Screen 2003; 9:74-82. [PMID: 12133927 DOI: 10.1136/jms.9.2.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little is known about the factors influencing the risk of recall for assessment, invasive diagnostic procedures, and early rescreening after screening mammography. METHODS From June 1996 to March 1998 women attending screening at 10 National Health Service Breast Screening Programme (NHSBSP) centres completed a self administered questionnaire and were followed up for their screening outcome. RESULTS 1969 (3.3%) out of 60 443 women aged 50-64 who had never used hormone replacement therapy (HRT) were recalled for assessment but were not diagnosed with breast cancer (defined here as false positive recall). After adjustment for the variation between centres, false positive recall was decreased significantly among women who were likely to have had a previous NHSBSP mammogram (odds ratio (OR) 0.49, 95% confidence interval (95% CI) 0.38 to 0.63 for likely versus unlikely), who were postmenopausal (OR 0.65, 95% CI 0.56 to 0.76 for postmenopausal v premenopausal) and increased significantly for women reporting previous breast surgery (OR 1.64, 95% CI 1.42 to 1.89). Although false positive recall decreased significantly with parity and increasing body mass index, these effects were not large and no significant variation was found with age, education, family history of breast cancer, oral contraceptive use, sterilisation, exercise, smoking, or alcohol consumption. Altogether 655 (1.1%) women had an invasive diagnostic procedure; no personal characteristics were predictive of this outcome, 286(0.5%) were referred for early rescreening, and this was increased significantly by nulliparity and a family history of breast cancer. INTERPRETATION Premenopausal women, those without a previous NHSBSP mammogram, and women with previous breast surgery have an increased risk of false positive recall by the NHSBSP.
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Affiliation(s)
- E Banks
- Cancer Research UK, Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK.
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Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, Heath CW, Coates RJ, Liff JM, Talamini R, Chantarakul N, Koetsawang S, Rachawat D, Morabia A, Schuman L, Stewart W, Szklo M, Bain C, Schofield F, Siskind V, Band P, Coldman AJ, Gallagher RP, Hislop TG, Yang P, Kolonel LM, Nomura AMY, Hu J, Johnson KC, Mao Y, De Sanjosé S, Lee N, Marchbanks P, Ory HW, Peterson HB, Wilson HG, Wingo PA, Ebeling K, Kunde D, Nishan P, Hopper JL, Colditz G, Gajalanski V, Martin N, Pardthaisong T, Silpisornkosol S, Theetranont C, Boosiri B, Chutivongse S, Jimakorn P, Virutamasen P, Wongsrichanalai C, Ewertz M, Adami HO, Bergkvist L, Magnusson C, Persson I, Chang-Claude J, Paul C, Skegg DCG, Spears GFS, Boyle P, Evstifeeva T, Daling JR, Hutchinson WB, Malone K, Noonan EA, Stanford JL, Thomas DB, Weiss NS, White E, Andrieu N, Brêmond A, Clavel F, Gairard B, Lansac J, Piana L, Renaud R, Izquierdo A, Viladiu P, Cuevas HR, Ontiveros P, Palet A, Salazar SB, Aristizabel N, Cuadros A, Tryggvadottir L, Tulinius H, Bachelot A, Lê MG, Peto J, Franceschi S, Lubin F, Modan B, Ron E, Wax Y, Friedman GD, Hiatt RA, Levi F, Bishop T, Kosmelj K, Primic-Zakelj M, Ravnihar B, Stare J, Beeson WL, Fraser G, Bullbrook RD, Cuzick J, Duffy SW, Fentiman IS, Hayward JL, Wang DY, McMichael AJ, McPherson K, Hanson RL, Leske MC, Mahoney MC, Nasca PC, Varma AO, Weinstein AL, Moller TR, Olsson H, Ranstam J, Goldbohm RA, van den Brandt PA, Apelo RA, Baens J, de la Cruz JR, Javier B, Lacaya LB, Ngelangel CA, La Vecchia C, Negri E, Marubini E, Ferraroni M, Gerber M, Richardson S, Segala C, Gatei D, Kenya P, Kungu A, Mati JG, Brinton LA, Hoover R, Schairer C, Spirtas R, Lee HP, Rookus MA, van Leeuwen FE, Schoenberg JA, McCredie M, Gammon MD, Clarke EA, Jones L, Neil A, Vessey M, Yeates D, Appleby P, Banks E, Beral V, Bull D, Crossley B, Goodill A, Green J, Hermon C, Key T, Langston N, Lewis C, Reeves G, Collins R, Doll R, Peto R, Mabuchi K, Preston D, Hannaford P, Kay C, Rosero-Bixby L, Gao YT, Jin F, Yuan JM, Wei HY, Yun T, Zhiheng C, Berry G, Cooper Booth J, Jelihovsky T, MacLennan R, Shearman R, Wang QS, Baines CJ, Miller AB, Wall C, Lund E, Stalsberg H, Shu XO, Zheng W, Katsouyanni K, Trichopoulou A, Trichopoulos D, Dabancens A, Martinez L, Molina R, Salas O, Alexander FE, Anderson K, Folsom AR, Hulka BS, Bernstein L, Enger S, Haile RW, Paganini-Hill A, Pike MC, Ross RK, Ursin G, Yu MC, Longnecker MP, Newcomb P, Bergkvist L, Kalache A, Farley TMM, Holck S, Meirik O. Alcohol, tobacco and breast cancer--collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer 2002; 87:1234-45. [PMID: 12439712 PMCID: PMC2562507 DOI: 10.1038/sj.bjc.6600596] [Citation(s) in RCA: 675] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2002] [Revised: 08/08/2002] [Accepted: 08/23/2002] [Indexed: 12/11/2022] Open
Abstract
Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58,515 women with invasive breast cancer and 95,067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for >/=45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.
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Affiliation(s)
- N Hamajima
- Cancer Research UK Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK
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Banks E, Beral V, Cameron R, Hogg A, Langley N, Barnes I, Bull D, Elliman J, Harris CL. Agreement between general practice prescription data and self-reported use of hormone replacement therapy and treatment for various illnesses. J Epidemiol Biostat 2002; 6:357-63. [PMID: 12036270 DOI: 10.1080/13595220152601837] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Epidemiological studies of the effects of hormone replacement therapy (HRT) often rely on exposure data and information on past health from self-administered questionnaires. The accuracy with which women report current use of HRT and the specific preparation in use is not known. This study aims to compare aspects of self-reported use of HRT and treatment for various conditions with data from general practice prescription records. METHODS Reported questionnaire data on use of HRT were compared with those on the general practice prescription record for 570 women participating in the Million Women Study from two general practices in the UK. RESULTS There was excellent agreement between data from the self-administered questionnaire and the prescription record: 96% agreement (kappa = 0.91) for current use of HRT, 95% agreement (kappa = 0.90) for any use of HRT during the period covered by the prescription record, and 97% agreement (kappa = 0.95) among current users for whether the HRT preparation contained oestrogen alone, combined oestrogen/progestogen, or some other constituents. Among former HRT users who provided questionnaire information on the preparation they used most recently, there was 69% agreement on the proprietary preparation used and 97% agreement (kappa = 0.93) on the hormonal constituents used. Agreement between reported treatment for various conditions and the presence of a prescription appropriate for that condition ranged from 89-99% (kappa 0.53-0.92), and was highest for thyroid disease and asthma. CONCLUSION Important aspects of use of HRT, such as type of preparation currently being used, are reported very reliably by women completing a self-administered questionnaire.
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Affiliation(s)
- E Banks
- Imperial Cancer Research Fund Cancer Epidemiology Unit, Radcliffe Infirmary, Oxford, UK
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Reisman A, Banks E. Reactions of the Group VB Pentoxides. VIII. Thermal, Density and X-Ray Studies of the Systems KNbO3-NaNbO3 and KTaO3-KNbO3. J Am Chem Soc 2002. [DOI: 10.1021/ja01541a024] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Okamoto Y, Ueba Y, Nagata I, Banks E. Rare earth metal-containing polymers. 4. Energy transfer from uranyl to europium ions in ionomers. Macromolecules 2002. [DOI: 10.1021/ma50004a065] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Okamoto Y, Ueba Y, Dzhanibekov NF, Banks E. Rare earth metal containing polymers. 3. Characterization of ion-containing polymer structures using rare earth metal fluorescence probes. Macromolecules 2002. [DOI: 10.1021/ma50002a003] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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