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Background: The aim of this study is to develop a method we call "cost mining" to unravel cost variation and identify cost drivers by modelling integrated patient pathways from primary care to the palliative care setting. This approach fills an urgent need to quantify financial strains on healthcare systems, particularly for colorectal cancer, which is the most expensive cancer in Australia, and the second most expensive cancer globally., Methods: We developed and published a customized algorithm that dynamically estimates and visualizes the mean, minimum, and total costs of care at the patient level, by aggregating activity-based healthcare system costs (e.g. DRGs) across integrated pathways. This extends traditional process mining approaches by making the resulting process maps actionable and informative and by displaying cost estimates. We demonstrate the method by constructing a unique dataset of colorectal cancer pathways in Victoria, Australia, using records of primary care, diagnosis, hospital admission and chemotherapy, medication, health system costs, and life events to create integrated colorectal cancer patient pathways from 2012 to 2020., Results: Cost mining with the algorithm enabled exploration of costly integrated pathways, i.e. drilling down in high-cost pathways to discover cost drivers, for 4246 cases covering approx. 4 million care activities. Per-patient CRC pathway costs ranged from $10,379 AUD to $41,643 AUD, and varied significantly per cancer stage such that e.g. chemotherapy costs in one cancer stage are different to the same chemotherapy regimen in a different stage. Admitted episodes were most costly, representing 93.34% or $56.6 M AUD of the total healthcare system costs covered in the sample., Conclusions: Cost mining can supplement other health economic methods by providing contextual, sequence and timing-related information depicting how patients flow through complex care pathways. This approach can also facilitate health economic studies informing decision-makers on where to target care improvement or to evaluate the consequences of new treatments or care delivery interventions. Through this study we provide an approach for hospitals and policymakers to leverage their health data infrastructure and to enable real time patient level cost mining., Competing Interests: Declarations. Ethics approval and consent to participate: The study received ethical approval by the Royal Melbourne Hospital Ethics Board through BioGrid application number 202003/8 (Australia). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Colorectal cancer (CRC) incidence is rising among adults under the age of 50 (early- or young-onset CRC). This population is more likely to have advanced-stage disease at diagnosis, suggesting their diagnostic pathway may be prolonged. To better understand factors influencing this pathway, this study explored patients' experiences of decision-making during a diagnosis of young-onset CRC., Methods: Semi-structured interviews were conducted with 17 participants with young-onset CRC diagnosed in 2021-2022 in Victoria, Australia. Interviews were conducted online or by phone an average 7 months (range 1-13) after diagnosis. Analysis was approached from a critical realist perspective, with themes developed inductively using reflexive thematic analysis., Results: Five themes were identified: Shifting Perception of Urgency, Multidimensional Perception of Role, Making the Most of Resources, Stage of Life, and COVID Adds Complexity. Participants' decision-making evolved over the diagnostic period. As participants perceived urgency to act, they took on a more active role in decision-making, utilising personal resources to access timely care. Their decisions were shaped by stage-of-life considerations, including employment and caring for a young family, with the COVID-19 pandemic adding "…a whole other layer of complexity" to the process., Conclusions: Younger adults with CRC make decisions in the context of unique considerations, adapting to reduce time to diagnosis, with decisions complicated by the COVID-19 pandemic. Greater support from health care providers/systems in the diagnostic period may improve timeliness of CRC diagnosis and outcomes in younger adults., (© 2024 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.)

Background: The incidence of pancreatic cancer is rising. With improvements in knowledge for screening and early detection, earlier detection of pancreatic cancer will continue to be more common. To support workforce planning, our aim is to perform a model-based analysis that simulates the potential impact on the healthcare workforce, assuming an earlier diagnosis of pancreatic cancer., Methods: We developed a simulation model to estimate the demand (i.e. new cases of pancreatic cancer) and supply (i.e. the healthcare workforce including general surgeons, medical oncologists, radiation oncologists, pain medicine physicians, and palliative care physicians) between 2023 and 2027 in Victoria, Australia. The model compares the current scenario to one in which pancreatic cancer is diagnosed at an earlier stage. The incidence of pancreatic cancer in Victoria, five-year survival rates, and Victoria's population size were obtained from Victorian Cancer Registry, Cancer Council NSW, and Australian Bureau of Statistics respectively. The healthcare workforce data were sourced from the Australian Government Department of Health and Aged Care's Health Workforce Data. The model was constructed at the remoteness level. We analysed the new cases and the number of healthcare workforce by profession together to assess the impact on the healthcare workforce., Results: In the status quo, over the next five years, there will be 198 to 220 stages I-II, 297 to 330 stage III, and 495 to 550 stage IV pancreatic cancer cases diagnosed annually, respectively. Assuming 20-70% of the shift towards pancreatic cancer's earlier diagnosis (shifting from stage IV to stages I-II pancreatic cancer within one year), the stages I-II cases could increase to 351 to 390 or 598 to 665 per year. The shift to early diagnosis led to substantial survival gains, translating into an additional 284 or 795 out of 5246 patients with pancreatic cancer remaining alive up to year 5 post-diagnosis. Workforce supply decreases significantly by the remoteness levels, and remote areas face a shortage of key medical professionals registered in delivering pancreatic cancer care, suggesting travel necessities by patients or clinicians., Conclusion: Improving the early detection and diagnosis of pancreatic cancer is expected to bring significant survival benefits, although there are workforce distribution imbalances in Victoria that may affect the ability to achieve the anticipated survival gain., (© 2024. The Author(s).)

Background and Objectives: Colorectal cancer (CRC) survival in Australia differs by health insurance status, but why this occurs is uncertain. There are growing concerns about out-of-pocket healthcare costs. We examined patient experiences of referral pathways to diagnosis and treatment of CRC in Victoria, Australia, and discussions about costs, comparing public, private and mixed healthcare system users., Method: Semistructured telephone interviews were conducted with 16 purposively sampled, English-speaking patients aged ≥40 years with CRC. Interviews were recorded, transcribed and analysed thematically., Results: Private patients described greater out-of-pocket expenses balanced by greater choice of provider and access. Public patients perceived limited choice in their diagnostic or treatment provider, although some considered switching systems. Patients trusted their general practitioner or specialist for referrals. Discussions about costs did not meet guideline recommendations., Discussion: There are limited opportunities for informed decision making about public versus private care for cancer diagnosis and treatment, which could contribute to inequalities in outcomes.

Objectives: A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK., Setting: Primary care in 10 jurisdictions., Participant: Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data., Primary and Secondary Outcome Measures: Patient, primary care, diagnostic and treatment intervals., Results: Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario)., Conclusions: Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Introduction: COVID-19 has impacted lives worldwide. Public health guidance has advocated for minimisation of infection risk by encouraging social isolation and physical distancing. In response, many health services have changed delivery practices to increased use of telehealth. We undertook an audit of hospital attendance data collected from a radiation oncology service in a large public hospital in Victoria, Australia between January and September in 2019, and the same period in 2020. The aim was to discern the impact of COVID-19 on attendance at appointments and whether attendance rates differed by appointment type., Methods: Attendance data and appointment type for the two targeted periods (a total of 62,528 appointments for 3383 patients) were extracted from the database maintained by the radiation oncology service. Logistic generalised estimating equation (GEE) models were run with the final model including the COVID-19 period (pre, during) and all patient and appointment characteristics., Results: Results indicated a small decrease in attendance in 2020 (OR = 1.13, 95% CI 1.01-1.25, P = 0.026) with this predominantly reported for the non-treatment appointments, which consisted of follow-up appointments, nurse appointments, and treatment review appointments., Conclusion: Attendance for radiation oncology treatment was largely unaffected by COVID-19 although other services experienced slight reductions. Changes to work practices, specifically the increased use of telehealth, may have moderated the impact. Given the focus on one service in one location, it is not possible to generalise these results and future research should closely monitor both patient and staff satisfaction with services delivered via modified processes., (© 2022 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.)

Issue Addressed: Introduced relatively recently in the Australian market, flavour capsule cigarettes pose a risk to adolescents by providing a palatable pathway to smoking initiation. The present study aimed to establish the prevalence of the use of flavour capsule cigarettes in Australian adolescents and to examine the association between frequency of use and smoking behaviour and intentions and perceptions of cigarette brand differences., Methods: Data were from a 2017 cross-sectional school-based survey of secondary students aged 12-17 years (N = 4266) in Victoria who self-reported their smoking behaviours, smoking intentions and cigarette brand perceptions. Regression analyses were conducted controlling for sex, age group, education sector and other covariates., Results: Overall, 5% (n = 195) of all students reported ever using flavour capsule cigarettes. Of the 675 students who had ever smoked, 29% (n = 194) had tried a flavour capsule cigarette. The likelihood of past-month and past-week smoking was significantly higher, and future smoking intentions were significantly stronger, for ever-smokers who had used flavour capsule cigarettes multiple times compared to those who had never used this type of cigarette. Ever-smokers were more likely to agree that 'some brands of cigarettes are easier to smoke than others' if they had tried a flavour capsule cigarette., Conclusions: There are high levels of use of flavour capsule cigarettes among Australian adolescent smokers, with more frequent use associated with greater involvement in smoking. SO WHAT?: These findings add to those of other studies suggesting that flavour capsule cigarettes may have negative impacts on youth smoking, strengthening the case for their prohibition in Australia., (© 2021 Australian Health Promotion Association.)

Introduction: Fear of cancer recurrence (FCR) is a common condition among cancer survivors that can lead to significant levels of distress, anxiety and depression. Online mindfulness programmes may provide the mechanism to support cancer survivors manage FCR and distress, and improve people's well-being over the short, medium and long term. The primary aim of this study is to determine the potential efficacy of MindOnLine, a 9 session mindfulness-based programme for survivors of breast, prostate and colorectal cancer. A formal economic programme will also be conducted., Methods and Analysis: A single-blind randomised controlled trial to determine the efficacy and cost-efficacy of a MindOnLine programme for cancer survivors. A total of 400 people living with cancer will be recruited via online advertisements on social media platforms, peak consumer advocacy groups or through outpatient services at healthcare providers across Victoria, Australia. People will be randomly allocated to either the MindOnLine programme (n=200) or waitlist control (n=200). Participant assessments will occur at baseline, at 9 weeks and 9-month follow-up. The primary outcome is change in Fear of Recurrence Index Score total score between baseline and 9 weeks; secondary outcomes are changes in depression and anxiety, quality of life and mindfulness. The economic analysis comprises a cost-consequences analysis where all outcomes will be compared with costs., Ethics and Dissemination: Ethics approval was obtained from the Peter MacCallum Cancer Centre (20-53) and Deakin University (2020-284). All participants will be required to provide written informed consent. Findings will be disseminated in peer reviewed journals and among key stakeholder organisations including hospitals, cancer and community organisations and Government. If successful the project will be rolled out nationally with a formal implementation plan., Trial Registration Number: Australian New Zealand Clinical Trials Registry (12620000645954); Pre-results. Registered 6 June 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379520&isReview=true., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale, Aims, and Objectives: Care pathway policies for cancer aim to reduce variation and improve the quality of patient care, and there is increasing evidence that adherence to such pathways is associated with improved survival and lower health care costs. Australia is implementing Optimal Care Pathways (OCPs) for several cancers, including colorectal cancer, but studies evaluating how well care conforms to OCP recommendations are rare. This study examined concordance between OCP recommendations and colorectal cancer care prior to policy rollout and disparities for vulnerable populations., Method: Cross-sectional survey (2012-2014) of cancer registry-identified colorectal cancer patients aged ≥40 approached within 6 months of diagnosis (n = 433), their general practitioner (GP, n = 290), and specialist (n = 144) in Victoria, Australia. We measured concordance with 10 OCP recommendations and variation by geography, socio-economic, and health insurance status using age- and sex-adjusted logistic regression models., Results: Use of recommended GP investigations varied from 66% for colonoscopy to 13% for digital rectal exam. Recommended waiting times to receive a colonoscopy, see a specialist after referral, and begin adjuvant chemotherapy were exceeded for around a third of patients. Twenty-eight percent of specialists reported a pretreatment multidisciplinary meeting. Most patients received surgery in a hospital with an intensive care unit (92%) and chemotherapy for high risk disease (84%). In general, care was similar across sociodemographic groups. However, receipt of GP investigations tended to be higher and waiting times longer for rural, low socio-economic, and non-privately insured patients. For example, receiving a colonoscopy within 4 weeks was significantly less likely for rural (51%) than urban (78%) patients (odds ratio = 0.30; 95% confidence interval, 0.11-0.79)., Conclusion: Prior to implementation, a significant proportion of colorectal cancer patients received care that did not meet OCP recommendations. Low concordance and inequities for rural and disadvantaged populations highlight components of the pathway to target during policy implementation., (© 2019 John Wiley & Sons, Ltd.)

Background: Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis., Methods: Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age., Results: One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than 'investigation' patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant., Conclusion: Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To investigate whether the density of tobacco retail outlets near schools in Victoria, Australia, is associated with adolescent smoking behaviour., Methods: Cross-sectional survey data of 2,044 secondary school students aged 12-17 years was combined with tobacco outlet audit data. Associations between students' self-reported tobacco use and the density of tobacco outlets near schools was examined using multilevel logistic and negative binomial regression models, with cigarette price at local milk bars and key socio-demographic and school-related variables included as covariates., Results: Increased tobacco retail outlet density was associated with a significant increase in the number of cigarettes smoked in the previous seven days among students who smoked in the past month (IRR=1.13; 95% CI 1.02-1.26), but not the odds of smoking in the past month in the larger sample (OR=1.06; 95% CI 0.90-1.24), after controlling for local mean price of cigarettes and socio-demographic and school-related variables., Conclusions and Implications: This study suggests there is a positive association between tobacco retail outlet density and cigarette consumption among adolescent smokers, but not smoking prevalence, in the Australian context. There is value in considering policy measures that restrict the supply of tobacco retail outlets in school neighbourhoods as a means of reducing youth cigarette consumption.

Objective: To describe the contemporary patterns of care for renal cell carcinoma (RCC) using a whole of population series from Victoria., Patients and Methods: Retrospective review of medical records of all patients diagnosed and treated for RCC in Victoria in 2009. Patients were identified via the State-wide Victorian Cancer Registry. Patient demographic characteristics, symptoms, stage, and first-line treatment were assessed. Associations between case residential location (metropolitan or rural) and treatment were examined using multivariate logistic regression after adjusting for age, sex, socioeconomic status, treatment in private or public hospital and comorbidity., Results: Data were obtained for 499 of 577 eligible patients. In all, 413 patients (83%) underwent surgery. Laparoscopic radical nephrectomy (RN) was the most common procedure for Stage I pT1a/pT1b tumours (51.2%); partial nephrectomy (PN) was performed for 27% of Stage I RCC In multivariate analysis, regional patients were less likely to receive PN (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18-0.85) for Stage I RCC, and less likely to receive systemic therapy for Stage IV RCC (OR 0.06, 95% CI 0.01-0.41). Multidisciplinary team meetings were recorded for only 25% of patients and 3% were enrolled in a clinical trial., Conclusion: Most contemporary patients diagnosed with RCC are still treated with RN, including those with smaller tumours amenable to PN. This may impact future outcomes, including increased risk of chronic kidney disease and its potential financial healthcare burden. Patterns of treatment also appear to differ between metropolitan and regional populations., (© 2013 The Authors. BJU International published by John Wiley & Sons Ltd.)

Objectives: To assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP., Design: Surveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures., Setting: 19 selected RACFs in Victoria., Participants: 12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour., Results: Findings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support., Conclusions: Surveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained.

Objectives: To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention., Design: An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention., Participants and Setting: 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria., Results: Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans., Conclusions: Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.

Background: Clinical practice guidelines/recommendations have been promoted as a mechanism for ensuring evidence-based medicine. We examine the impact of the publication of Australian treatment recommendations (ATR) for ductal carcinoma in situ (DCIS) on clinical practice and surgeons' attitudes to the ATR., Methods: All new cases of DCIS diagnosed in the 12-months immediately before the ATR release (pre-ATR: September 2002 to August 2003) and three years later (post-ATR: September 2006 to August 2007) were identified from the state of Victoria's population cancer registry. Treatment information, extracted for each case by treating surgeon or study manager, was available for 342 of 353 (97%) tumours pre-ATR and 371 of 378 (98%) tumours post-ATR. Sixty-three surgeons (58% response) completed a survey on awareness and attitudes to the ATR., Results: The proportion of cases undergoing image-guided biopsy, or breast conservation surgery (BCS) did not change between surveys nor did extent of surgical margins. Compared to the pre-ATR period, more BCS cases were referred to a radiation oncologist (67% versus 58%) and more received radiotherapy (53% versus 44%) post-ATR. Tumours greater than 20 mm, of intermediate grade and moderate necrosis were more likely to receive radiotherapy post-ATR. While surgeons agreed with most recommendations, items reflecting radiotherapy recommendations generated most disagreement., Conclusion: With the possible exception of adjuvant radiotherapy, most DCIS cases were treated according to treatment recommendations before the ATR's release. The lack of change in radiotherapy for low grade, smaller tumours may reflect surgeon's uncertainty regarding this therapy for all BCS treated cases., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Anti-smoking advertisements are an effective population-based smoking reduction strategy. The Quitline telephone service provides a first point of contact for adults considering quitting. Because of data complexity, the relationship between anti-smoking advertising placement, intensity, and time trends in total call volume is poorly understood. In this study we use a recently developed semi-varying coefficient model to elucidate this relationship., Methods: Semi-varying coefficient models comprise parametric and nonparametric components. The model is fitted to the daily number of calls to Quitline in Victoria, Australia to estimate a nonparametric long-term trend and parametric terms for day-of-the-week effects and to clarify the relationship with target audience rating points (TARPs) for the Quit and nicotine replacement advertising campaigns., Results: The number of calls to Quitline increased with the TARP value of both the Quit and other smoking cessation advertisement; the TARP values associated with the Quit program were almost twice as effective. The varying coefficient term was statistically significant for peak periods with little or no advertising., Conclusions: Semi-varying coefficient models are useful for modeling public health data when there is little or no information on other factors related to the at-risk population. These models are well suited to modeling call volume to Quitline, because the varying coefficient allowed the underlying time trend to depend on fixed covariates that also vary with time, thereby explaining more of the variation in the call model.

Objective: To examine whether students use or avoid newly shaded areas created by shade sails installed at schools., Design: Cluster randomised controlled trial with secondary schools as the unit of randomisation., Setting: 51 secondary schools with limited available shade, in Australia, assessed over two spring and summer terms., Participants: Students outside at lunch times., Intervention: Purpose built shade sails were installed in winter 2005 at full sun study sites to increase available shade for students in the school grounds., Main Outcome Measure: Mean number of students using the primary study sites during weekly observations at lunch time., Results: Over the study period the mean change in students using the primary study site from pre-test to post-test was 2.63 (95% confidence interval 0.87 to 4.39) students in intervention schools and -0.03 (-1.16 to 1.09) students in control schools. The difference in mean change between groups was 2.67 (0.65 to 4.68) students (P=0.011)., Conclusions: Students used rather than avoided newly shaded areas provided by purpose built shade sails at secondary schools in this trial, suggesting a practical means of reducing adolescents' exposure to ultraviolet radiation., Trial Registration: Exempt.

Study Objectives: Quitline-an antismoking advertising and a telephone helpline service-is an effective public health intervention strategy for tobacco control. The objective of this short report is to model the relation between placement of antismoking advertisements and calls to Quitline on a given day., Methods/design: Data on daily Quitline antismoking advertisements, television target audience rating points (TARPS), and calls to Quitline Victoria were studied for the period 1 August 2000 and 31 July 2001. The outcome-calls to Quitline-is a count and thus assumed to follow a Poisson distribution. Generalised partial linear models were used to model the logarithm of mean daily calls as a non-parametric function of time and a linear parametric function of the day of week, number of advertisements, and TARPS., Main Results: Peak calls to Quitline Victoria occurred during Monday to Wednesday with around three times as many calls compared with Sunday. Both placement of Quitline advertisements (p<0.001) and an increase in TARPS (p<0.001) on a given day significantly increased the number of calls made to Quitline Victoria. The model adequately captured fluctuations in call volume and diagnostics showed no model inadequacy., Conclusions: In this short report the emphasis is on modelling the parametric components-day of week, placement of advertisements, and TARPS on call volume. The dynamics of the underlying time trend in call volume is captured in a non-parametric component. Future analysis of hourly data would provide additional information to assess different media buying strategies that might increase call volume.

Background: This study examines changes in the management of ductal carcinoma in situ between 1995 and 1999 in the Australian State of Victoria. This period was before the release of Australian treatment recommendations., Methods: All new cases of ductal carcinoma in situ diagnosed between 1 April and 30 September in 1995 and 1999 were identified from the population cancer registry. Treating surgeons completed a questionnaire on the presentation and management of each case. In 1995, 64 out of 70 surgeons returned questionnaires for 137 cases (case response, 94%). In 1999, 68 surgeons treated 159 registered cases and 141 completed surveys were returned (case response, 89%)., Results: More cases underwent an image-guided biopsy in 1999 (54%) than in 1995 (34%). Breast-conserving surgery (BCS) was used to treat 69% of cases in 1999 and 63% in 1995. The use of axillary procedures (clearance or sampling) for women treated by mastectomy decreased from 61% in 1995 to 30% in 1999. More patients treated with BCS had margins simply described as "clear" in 1995 (49%) than in 1999 (21%). In 1995, only 7% of cases treated with BCS had radiotherapy, and this was 25% in 1999., Conclusion: In both 1999 and 1995, the majority of patients were treated by BCS, but only a minority received radiotherapy.

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast prosthesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government's Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision.

Background: To determine the independent contribution of behavioral factors to the occurrence of sunburn, sun protection behavior was assessed over 13 successive summer weekends in a total of 1,655 adults in Melbourne, Australia., Methods: Telephone survey respondents provided detailed accounts of activities engaged in, time spent outside, and hat, clothing, and sunscreen coverage in the 4 hr around the solar midday on both weekend days, as well as skin type, sociodemographic descriptors, and degree of sunburn experienced. Independent measures of atmospheric temperature and ambient ultraviolet radiation (UVR) were added to individual records., Results: The (mostly recreational) weekend sunburn in this urban sample was strongly associated with UVR, as expected. Temperature at 3 PM, sensitive skin type, youthfulness, and being male were also independently associated with sunburn. After all other predictors were controlled for, the body exposure index (which took into account time outside and hat, clothing, and sunscreen coverage) made a strong independent contribution to the explanation of sunburn (P < 0.001)., Conclusion: It was concluded that behavior change strategies to prevent malignant melanoma of the skin are warranted.

Participants in the Mammacheck breast self-examination (BSE) training program were surveyed to assess the characteristics of women choosing to attend BSE training sessions, as well as to assess the factors that related to their BSE practice prior to attending the session. In all, 5,673 women completed questionnaires. In comparison with the general population, women who attended Mammacheck tended to be younger, married, and more highly educated, but did not differ in relation to prior experience of breast problems. Previous BSE practice related predominantly to the amount of knowledge about BSE the women reported that they had acquired before attending a training session. The findings highlight the importance of education and raised the important question of how to teach women with lower education levels and little or no knowledge about BSE. Recommendations are made.