http://hdl.handle.net/2440/13901 Sat, 18 May 2013 13:41:27 GMT 2013-05-18T13:41:27Z http://hdl.handle.net/2440/77778 Title: Theorising survival : indigenous women and social and emotional wellbeing Author: Baker, Jennifer Sat, 31 Dec 2011 13:30:00 GMT http://hdl.handle.net/2440/77778 2011-12-31T13:30:00Z http://hdl.handle.net/2440/77747 Title: Engaging stakeholders in an adaptation process: governance and institutional arrangements in heat-health policy development in Adelaide, Australia Author: Akompab, Derick Akoku; Bi, Peng; Williams, Susan Gay; Saniotis, Arthur; Walker, Iain; Augoustinos, Martha Abstract: Record breaking heat waves have been recorded in Adelaide, Australia in recent years and climate change would likely increase the frequency, duration and severity of heat waves. This paper describes the governance and institutional arrangements during the development of an adaptation strategy (herein referred to as heat-health policy) for heat waves in Adelaide, Australia. In-depth, semi-structured interviews were conducted between June and August 2011 among 18 stakeholders who were involved in the participatory process during the development of the heat-health policy. Informed consent was obtained and interviews were recorded, transcribed verbatim and the data analysed using framework analysis. Interview data were supplemented by data gathered through a review of documents associated with the process. The results found that the process of developing the heat-health policy was initiated by the state government and comprised of stakeholders from both the state and non-state sectors. There was a high level of leadership and political commitment demonstrated during the process, given that the different players wanted a policy to be in place before any future heat wave. A Steering Committee was established that provided coordination and oversight in addition to the Emergency Management Act within the state which provided the legislative framework during the heat-health policy development process. Although the decision-making authority was controlled by a controlled by a public institution, to a larger extent, there was collaborative decision-making by virtue of the context in which the heat-health policy was developed. An assurance mechanism established during the process was among the factors that ensured accountability during the participatory process. Overall, the development of the heat-health policy in Adelaide was largely successful, attributed to the extent of political commitment from the state government and the sound institutional and legislative framework that facilitated the process. Good governance and institutional arrangements provide the enabling environment, the structures, systems and resources that would facilitate the development of adaptation strategies such as heat-health policies. Description: Extent: 18p. Sat, 31 Dec 2011 13:30:00 GMT http://hdl.handle.net/2440/77747 2011-12-31T13:30:00Z http://hdl.handle.net/2440/77730 Title: Estimating prevalence of distant metastatic breast cancer: a means of filling a data gap Author: Clements, Mark S.; Roder, David Murray; Yu, Xue Qin; Egger, Sam; O'Connell, Dianne L. Abstract: PURPOSE: To develop and validate a method for estimating numbers of people with distant cancer metastases, for evidence-based service planning. METHODS: Estimates were made employing an illness-death model with distant metastatic cancer as the illness state- and site-specific mortality as an outcome, using MIAMOD software. To demonstrate the method, we estimated numbers of females alive in Australia following detection of distant metastatic breast cancer during 1980–2004, using data on patient survival from an Australian population-based cancer registry. We validated these estimates by comparing them with direct prevalence counts. RESULTS: Relative survival at 10 years following detection of distant metastases was low (5–20 %), with better survival experienced by: (1) females where distant metastatic disease was detected at initial diagnosis rather than subsequently (e.g., at recurrence); (2) those diagnosed in more recent calendar years; and (3) younger age groups. For Australian females aged less than 85 years, the modeled cumulative risk of detection of distant metastatic breast cancer (either at initial diagnosis or subsequently) declined over time, but numbers of cases with this history rose from 71 per 100,000 in 1980 to 84 per 100,000 in 2004. The model indicated that there were approximately 3–4 prevalent distant metastatic breast cancer cases for every breast cancer death. Comparison of estimates with direct prevalence counts showed a reasonable level of agreement. CONCLUSIONS: The method is straightforward to apply and we recommend its use for breast and other cancers when registry data are insufficient for direct prevalence counts. This will provide estimates of numbers of people who would need ongoing medical surveillance and care following detection of distant metastases. Sat, 31 Dec 2011 13:30:00 GMT http://hdl.handle.net/2440/77730 2011-12-31T13:30:00Z http://hdl.handle.net/2440/77723 Title: Survival from synchronous bilateral breast cancer: The experience of surgeons participating in the breast audit of the Society of Breast Surgeons of Australia and New Zealand Author: Roder, David Murray; de Silva, Primali; Zorbas, Helen; Kollias, James; Malycha, Peter; Pyke, Chris M.; Campbell, Ian D.; Webster, Fleur Abstract: Background: Previous studies generally indicate that synchronous bilateral breast cancers (SBBC) have an equivalent or moderately poorer survival compared with unilateral cases. The prognostic characteristics of SBBC would be relevant when planning adjuvant therapies and follow-up medical surveillance. The frequency of SBBC among early breast cancers in clinical settings in Australia and New Zealand was investigated, plus their prognostic significance, using the Breast Cancer Audit Database of the Society of Breast Surgeons of Australia and New Zealand, which covered an estimated 60% of early invasive lesions in those countries. Design: Rate ratios (95% confidence limits) of SBBC were investigated among 35,370 female breast cancer cases by age of woman, histology type, grade, tumour diameter, nodal status, lymphatic/vascular invasion and oestrogen receptor status. Univariate and multivariable disease-specific survival analyses were undertaken. Results: 2.3% of cases were found to be SBBC (i.e., diagnoses occurring within 3 months). The figure increased from 1.4% in women less than 40 years to 4.1% in those aged 80 years or more. Disease-specific survivals did not vary by SBBC status (p=0.206). After adjusting for age, histology type, diameter, grade, nodal status, lymphatic/vascular invasion, and oestrogen receptor status, the relative risk of breast cancer death for SBBC was 1.17 (95% CL: 0.91, 1.51). After adjusting for favourable prognostic factors more common in SBBC cases (i.e., histology type, grade, lymphatic/ vascular invasion, and oestrogen receptor status), the relative risk of breast cancer death for SBBC was 1.42 (95% CL: 1.10, 1.82). After adjusting for unfavourable prognostic factors more common in SBBC cases (i.e., older age and large tumour diameter), the relative risk of breast cancer death for SBBC was 0.98 (95% CL: 0.76, 1.26). Conclusions: Results confirm previous findings of an equivalent or moderately poorer survival for SBBC but indicate that SBBC status is likely to be an important prognostic indicator for some cases. Sat, 31 Dec 2011 13:30:00 GMT http://hdl.handle.net/2440/77723 2011-12-31T13:30:00Z