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Brennan ME, Marinovich ML, Verdonk B, Vukasovic M, Coggins A. Symptoms of anxiety, depression and fear in healthcare workers and non-healthcare workers undergoing outpatient COVID-19 testing in an urban Australian setting. Aust J Prim Health 2021; 27:442-449. [PMID: 34818513 DOI: 10.1071/py21139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022]
Abstract
This study assessed symptoms of anxiety, depression and fear of COVID-19 in members of the general community and healthcare workers (HCWs) attending for COVID testing. This cross-sectional study was conducted in a public hospital COVID-19 testing clinic (June-September 2020) using self-administered questionnaires (i.e. the Hospital Anxiety and Depression Scale (HADS) and the Fear of COVID-19 Scale). In all, 430 participants who met the criteria for COVID-19 testing with nasopharyngeal and throat swabs completed the questionnaires. The mean (±s.d.) age of participants was 37.6 ± 12.6 years. HCWs made up 35.1% of the sample. Overall, the mean (±s.d.) score for anxiety was 6.09 ± 4.41 and 'case' prevalence (any severity) was 151/430 (35.1%), higher than normative population scores. Higher anxiety was found in women (P = 0.001) and in clients who had previously been tested for coronavirus (P = 0.03). HCWs had lower anxiety scores than members of the general community (P = 0.001). For depression, the mean (±s.d.) score was 4.18 ± 3.60, with a 'case' prevalence (any severity) of 82/430 (19.1%), similar to normative population scores. Women reported a higher level of COVID-19 fear (P = 0.001), as did people with a lower education level (P = 0.001). A greater psychological impact of COVID-19 was observed in women, people undergoing repeat testing and participants reporting lower levels of educational attainment. HCWs had fewer symptoms of anxiety and depression than non-HCWs attending the same clinic for COVID-19 testing. This information can be used to plan mental health interventions in primary care and testing settings during this and future pandemics.
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Affiliation(s)
- M E Brennan
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia; and The University of Notre Dame Australia, School of Medicine, Sydney, NSW, Australia; and COVID-19 Clinic, Westmead Hospital, Westmead, NSW 2145, Australia; and Corresponding author.
| | - M L Marinovich
- Curtin School of Population Health, Curtin University, Perth, WA, Australia; and Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - B Verdonk
- COVID-19 Clinic, Westmead Hospital, Westmead, NSW 2145, Australia
| | - M Vukasovic
- Emergency Department, Westmead Hospital, Westmead, NSW 2145, Australia
| | - A Coggins
- Emergency Department, Westmead Hospital, Westmead, NSW 2145, Australia
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Marinovich ML, Regan AK, Gissler M, Magnus MC, Håberg SE, Mayo JA, Shaw GM, Bell J, Nassar N, Ball S, Gebremedhin AT, Marston C, de Klerk N, Betrán AP, Padula AM, Pereira G. Associations between interpregnancy interval and preterm birth by previous preterm birth status in four high-income countries: a cohort study. BJOG 2021; 128:1134-1143. [PMID: 33232573 DOI: 10.1111/1471-0528.16606] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effect of interpregnancy interval (IPI) on preterm birth (PTB) according to whether the previous birth was preterm or term. DESIGN Cohort study. SETTING USA (California), Australia, Finland, Norway (1980-2017). POPULATION Women who gave birth to first and second (n = 3 213 855) singleton livebirths. METHODS Odds ratios (ORs) for PTB according to IPIs were modelled using logistic regression with prognostic score stratification for potential confounders. Within-site ORs were pooled by random effects meta-analysis. OUTCOME MEASURE PTB (gestational age <37 weeks). RESULTS Absolute risk of PTB for each IPI was 3-6% after a previous term birth and 17-22% after previous PTB. ORs for PTB differed between previous term and preterm births in all countries (P-for-interaction ≤ 0.001). For women with a previous term birth, pooled ORs were increased for IPI <6 months (OR 1.50, 95% CI 1.43-1.58); 6-11 months (OR 1.10, 95% CI 1.04-1.16); 24-59 months (OR 1.16, 95% CI 1.13-1.18); and ≥ 60 months (OR 1.72, 95%CI 1.60-1.86), compared with 18-23 months. For previous PTB, ORs were increased for <6 months (OR 1.30, 95% CI 1.18-1.42) and ≥60 months (OR 1.29, 95% CI 1.17-1.42), but were less than ORs among women with a previous term birth (P < 0.05). CONCLUSIONS Associations between IPI and PTB are modified by whether or not the previous pregnancy was preterm. ORs for short and long IPIs were higher among women with a previous term birth than a previous PTB, which for short IPI is consistent with the maternal depletion hypothesis. Given the high risk of recurrence and assuming a causal association between IPI and PTB, IPI remains a potentially modifiable risk factor for women with previous PTB. TWEETABLE ABSTRACT Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.
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Affiliation(s)
- M L Marinovich
- School of Public Health, Curtin University, Perth, WA, Australia
| | - A K Regan
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - M Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - M C Magnus
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - S E Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - J A Mayo
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, USA
| | - G M Shaw
- Department of Pediatrics, March of Dimes Prematurity Research Center, Stanford University, Stanford, CA, USA
| | - J Bell
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - N Nassar
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - S Ball
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - A T Gebremedhin
- School of Public Health, Curtin University, Perth, WA, Australia
| | - C Marston
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N de Klerk
- Telethon Kids Institute, University of Western Australia, Subiaco, WA, Australia
| | - A P Betrán
- Department of Reproductive Health and Research, UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - A M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - G Pereira
- School of Public Health, Curtin University, Perth, WA, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- Telethon Kids Institute, University of Western Australia, Subiaco, WA, Australia
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Fancellu A, Houssami N, Sanna V, Porcu A, Ninniri C, Marinovich ML. Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis. Br J Surg 2021; 108:760-768. [PMID: 34057990 DOI: 10.1093/bjs/znab145] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND In patients with triple-negative breast cancer (TNBC), oncological and survival outcomes based on locoregional treatment are poorly understood. In particular, the safety of breast-conserving surgery (BCS) for TNBC has been questioned. METHODS A meta-analysis was performed to evaluate locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) rates in patients with TNBC who had breast-conserving surgery versus mastectomy. Estimates were pooled in random-effects analysis. The effect of study-level co-variables was assessed by univariable metaregression. RESULTS Fourteen studies, including 19 819 patients operated for TNBC met the inclusion criteria; 9828 patients (49.6 per cent) underwent BCS and 9991 (50.4 per cent) had a mastectomy. Patients with smaller tumours were more likely to be selected for BCS (pooled odds ratio (OR) for T1 tumours 1.95, 95 per cent c.i. 1.64 to 2.32; P < 0.001). The pooled OR for LRR was 0.64 (0.48 to 0.85; P = 0.002), indicating a statistically significantly lower odds of LRR among women who had BCS relative to mastectomy. The pooled OR for DM was 0.70 (0.53 to 0.94; P = 0.02), indicating a lower odds of DM among women who had BCS; however, this difference diminished with increasing study-level age and follow-up time. A pooled hazard ratio of 0.78 (0.69 to 0.89; P < 0.001) showed a significantly lower hazard for all-cause mortality among women undergoing BCS versus mastectomy. CONCLUSION These results should be interpreted cautiously owing to likely differences in selection for BCS or mastectomy in the included studies. Patients with TNBC selected for BCS do not, however, have a worse prognosis than those treated with mastectomy, and breast conservation can be offered when feasible clinically.
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Affiliation(s)
- A Fancellu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - N Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - V Sanna
- Azienda Ospedaliero-Universitaria di Sassari, Unit of Medical Oncology, Sassari, Italy
| | - A Porcu
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - C Ninniri
- Department of Medical, Surgical and Experimental Sciences, Unit of General Surgery 2, Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - M L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
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Taylor DB, Bourke AG, Westcott EJ, Marinovich ML, Chong CYL, Liang R, Hughes RL, Elder E, Saunders CM. Surgical outcomes after radioactive 125I seed versus hookwire localization of non-palpable breast cancer: a multicentre randomized clinical trial. Br J Surg 2021; 108:40-48. [PMID: 33640932 PMCID: PMC10364908 DOI: 10.1093/bjs/znaa008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/19/2020] [Accepted: 08/30/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer. METHODS Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights. RESULTS A total of 690 women were randomized at eight sites; 659 women remained after withdrawal (125I seed, 327; HWL, 332). Mean age was 60.3 years in the 125I seed group and 60.7 years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2 mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively; P = 0.019). There were no significant differences in positive margin rates, or in specimen weights and volumes. CONCLUSION Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (http://www.ANZCTR.org.au/).
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Affiliation(s)
- D B Taylor
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia
| | - A G Bourke
- Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia.,Breast Centre, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia
| | - E J Westcott
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - M L Marinovich
- School of Public Health, Curtin University, Bentley, Perth, Western Australia, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - C Y L Chong
- Monash Health School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - R Liang
- Department of Surgery, Gold Coast Hospital and Health Service, Robina, Queensland, Australia
| | - R L Hughes
- Radiology Department, Waikato District Health Board, Hamilton, New Zealand
| | - E Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Sydney, New South Wales, Australia
| | - C M Saunders
- Breast Clinic, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Surgery, Medical School, University of Western Australia, Crawley, Perth, Western Australia, Australia.,Breast Centre, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.,Department of Surgery, St John of God Hospital, Subiaco, Perth, Western Australia, Australia
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Wright CM, Moorin RE, Saunders C, Marinovich ML, Taylor DB. Cost-effectiveness of radioguided occult lesion localization using 125I seeds versus hookwire localization before breast-conserving surgery for non-palpable breast cancer. Br J Surg 2021; 108:843-850. [PMID: 33638646 DOI: 10.1093/bjs/znaa160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim was to determine the cost-effectiveness of radioguided occult lesion localization using 125I-labelled seeds (125I seeds) versus hookwire localization in terms of incremental cost per reoperation avoided for women with non-palpable breast cancer undergoing breast-conserving surgery. METHODS This study was based on a multicentre RCT with eight study sites comprising seven public hospitals and one private hospital. An Australian public health system perspective was taken. The primary effectiveness outcome for this study was reoperations avoided. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were used to explore uncertainty. The willingness to pay (additional cost of localization using 125I seeds justified by reoperation cost avoided) was set at the weighted, top-down cost of reoperation. Costs were in 2019 Australian dollars ($1 was equivalent to €0.62). RESULTS The reoperation rate was 13.9 (95 per cent confidence interval 10.7 to 18.0) per cent for the 125I seed group and 18.9 (14.8 to 23.8) per cent for the hookwire localization group. The ICER for 125I seed versus hookwire localization was $4474 per reoperation averted. The results were most sensitive to uncertainty around the probability of reoperation. Accounting for transition probability and cost uncertainty for 125I seed localization, there was a 77 per cent probability that using 125I seeds would be cost-effective, with a willingness to pay of $7693 per reoperation averted. CONCLUSION Radioguided occult lesion localization using 125I seeds is likely to be cost-effective, because the marginal (additional) cost compared with hookwire localization is less than the cost of reoperations avoided.
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Affiliation(s)
- C M Wright
- Health Economics and Data Analytics, School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - R E Moorin
- Health Economics and Data Analytics, School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Centre for Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - C Saunders
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - M L Marinovich
- Health Economics and Data Analytics, School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.,Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - D B Taylor
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia.,BreastScreen Western Australia, Perth, Western Australia, Australia
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