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1. Assessing the Variability of the Twelfth Rib as a Landmark for Percutaneous Nephrolithotomy Using Computed Tomography

Author

Tempo JA, Williams GM, Robertson IK, Rama DJ, Pascoe CEA, and Cetti RJ

Subjects
percutaneous nephrolithotomy, rib, anatomical marker, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Jake A Tempo,1 Georgina M Williams,1 Iain K Robertson,2,3 Darren J Rama,1 Claire EA Pascoe,1 Richard J Cetti1 1Department of Urology, Launceston General Hospital, Launceston, Tasmania, Australia; 2College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia; 3Clifford Craig Foundation, Launceston General Hospital, Launceston, Tasmania, AustraliaCorrespondence: Jake A Tempo, Department of Urology, Launceston General Hospital, 3/182 Hawdon Street, Heidelberg, VIC, Launceston, Tasmania, 3084, Australia, Tel +61448438937, Email jake.tempo@outlook.comBackground: The variability in length of the twelfth rib is mentioned in the literature but has never been formally studied. The highly variable rib length provides a challenge for urologists seeking a consistent landmark for Percutaneous Nephrolithotomy (PCNL). We set out to determine whether the twelfth rib is safe to use as a consistent landmark for surgery.Methods: Single centre, cross-sectional retrospective observational study and analysis of CT scans of 100 adults who had imaging between 23rd March and 12th April 2020. The distance from the mid-sagittal line to the twelfth rib tip in the axial plane was measured as was the distance from the twelfth rib tip to the kidney, spleen and liver.Results: Length from the mid-sagittal line to the right twelfth rib tip varied from 46 (percentile 95% CI 40 to 57) to 136mm (percentile 95% CI 133 to 138). On the left, the distances varied from 55 (percentile 95% CI 50 to 64) to 134mm (percentile 95% CI 131 to 135). Twenty-three percent of people had an organ lying between the tip of the twelfth rib and the kidney on the right and 11% on the left.Conclusion: The twelfth rib is highly variable in length. Similar variability was recorded in the distance from the tip to intra-abdominal organs. Due to the frequency of organs lying between the tip of the rib and the kidney it should not be used as a landmark for accessing the kidney without prior knowledge of an individual patient’s anatomy as seen on imaging.Keywords: percutaneous nephrolithotomy, rib, anatomical marker

Published
2023

8. On the estimation of population cause-specific mortality fractions from in-hospital deaths

Author

Williams, GM, Riley, ID, Hazard, RH, Chowhury, HR, Alam, N, Streafield, PK, Tallo, V, Sanvictores, D, Lucero, M, Adair, T, Lopez, AD, Williams, GM, Riley, ID, Hazard, RH, Chowhury, HR, Alam, N, Streafield, PK, Tallo, V, Sanvictores, D, Lucero, M, Adair, T, and Lopez, AD

Abstract

BACKGROUND: Almost all countries without complete vital registration systems have data on deaths collected by hospitals. However, these data have not been widely used to estimate cause of death (COD) patterns in populations because only a non-representative fraction of people in these countries die in health facilities. Methods that can exploit hospital mortality statistics to reliably estimate community COD patterns are required to strengthen the evidence base for disease and injury control programs. We propose a method that weights hospital-certified causes by the probability of death to estimate population cause-specific mortality fractions (CSMFs). METHODS: We used an established verbal autopsy instrument (VAI) to collect data from hospital catchment areas in Chandpur and Comilla Districts, Bangladesh, and Bohol province, the Philippines, between 2011 and 2014, along with demographic covariates for each death. Hospital medical certificates of cause of death (death certificates) were collected and mapped to the corresponding cause categories of the VAI. Tariff 2.0 was used to assign a COD for community deaths. Logistic regression models were created for broad causes in each country to calculate the probability of in-hospital death, given a set of covariate values. The reweighted CSMFs for deaths in the hospital catchment population, represented by each hospital death, were calculated from the corresponding regression models. RESULTS: We collected data on 4228 adult deaths in the Philippines and 3725 deaths in Bangladesh. Short time to hospital and education were consistently associated with in-hospital death in the Philippines and absence of a disability was consistently associated with in-hospital death in Bangladesh. Non-communicable diseases (excluding stroke) and stroke were the leading causes of death in both the Philippines (33.9%, 19.1%) and Bangladesh (46.1%, 21.1%) according to the reweighted method. The reweighted method generally estimated CSMFs that f

Published
2019

9. The Early Growth Genetics (EGG) and EArly Genetics and Lifecourse Epidemiology (EAGLE) consortia: design, results and future prospects

Author

Middeldorp, CM, Mahajan, A, Horikoshi, M, Robertson, NR, Beaumont, RN, Bradfield, JP, Bustamante, M, Cousminer, DL, Day, FR, De Silva, NM, Guxens, M, Mook-Kanamori, DO, St Pourcain, B, Warrington, NM, Adair, LS, Ahlqvist, E, Ahluwalia, TS, Almgren, P, Ang, W, Atalay, M, Auvinen, J, Bartels, M, Beckmann, JS, Bilbao, JR, Bond, T, Borja, JB, Cavadino, A, Charoen, P, Chen, Z, Coin, L, Cooper, C, Curtin, JA, Custovic, A, Das, S, Davies, GE, Dedoussis, GV, Duijts, L, Eastwood, PR, Eliasen, AU, Elliott, P, Eriksson, JG, Estivill, X, Fadista, J, Fedko, IO, Frayling, TM, Gaillard, R, Gauderman, WJ, Geller, F, Gilliland, F, Gilsanz, V, Granell, R, Grarup, N, Groop, L, Hadley, D, Hakonarson, H, Hansen, T, Hartman, CA, Hattersley, AT, Hayes, MG, Hebebrand, J, Heinrich, J, Helgeland, O, Henders, AK, Henderson, J, Henriksen, TB, Hirschhorn, JN, Hivert, M-F, Hocher, B, Holloway, JW, Holt, P, Hottenga, J-J, Hypponen, E, Iniguez, C, Johansson, S, Jugessur, A, Kahonen, M, Kalkwarf, HJ, Kaprio, J, Karhunen, V, Kemp, JP, Kerkhof, M, Koppelman, GH, Korner, A, Kotecha, S, Kreiner-Moller, E, Kulohoma, B, Kumar, A, Kutalik, Z, Lahti, J, Lappe, JM, Larsson, H, Lehtimaki, T, Lewin, AM, Li, J, Lichtenstein, P, Lindgren, CM, Lindi, V, Linneberg, A, Liu, X, Liu, J, Lowe, WL, Lundstrom, S, Lyytikainen, L-P, Ma, RCW, Mace, A, Magi, R, Magnus, P, Mamun, AA, Mannikko, M, Martin, NG, Mbarek, H, McCarthy, NS, Medland, SE, Melbye, M, Melen, E, Mohlke, KL, Monnereau, C, Morgen, CS, Morris, AP, Murray, JC, Myhre, R, Najman, JM, Nivard, MG, Nohr, EA, Nolte, IM, Ntalla, I, O'Reilly, P, Oberfield, SE, Oken, E, Oldehinkel, AJ, Pahkala, K, Palviainen, T, Panoutsopoulou, K, Pedersen, O, Pennell, CE, Pershagen, G, Pitkanen, N, Plomin, R, Power, C, Prasad, RB, Prokopenko, I, Pulkkinen, L, Raikkonen, K, Raitakari, OT, Reynolds, RM, Richmond, RC, Rivadeneira, F, Rodriguez, A, Rose, RJ, Salem, R, Santa-Marina, L, Saw, S-M, Schnurr, TM, Scott, JG, Selzam, S, Shepherd, JA, Simpson, A, Skotte, L, Sleiman, PMA, Snieder, H, Sorensen, TIA, Standl, M, Steegers, EAP, Strachan, DP, Straker, L, Strandberg, T, Taylor, M, Teo, Y-Y, Thiering, E, Torrent, M, Tyrrell, J, Uitterlinden, AG, van Beijsterveldt, T, van der Most, PJ, van Duijn, CM, Viikari, J, Vilor-Tejedor, N, Vogelezang, S, Vonk, JM, Vrijkotte, TGM, Vuoksimaa, E, Wang, CA, Watkins, WJ, Wichmann, H-E, Willemsen, G, Williams, GM, Wilson, JF, Wray, NR, Xu, S, Xu, C-J, Yaghootkar, H, Yi, L, Zafarmand, MH, Zeggini, E, Zemel, BS, Hinney, A, Lakka, TA, Whitehouse, AJO, Sunyer, J, Widen, EE, Feenstra, B, Sebert, S, Jacobsson, B, Njolstad, PR, Stoltenberg, C, Smith, GD, Lawlor, DA, Paternoster, L, Timpson, NJ, Ong, KK, Bisgaard, H, Bonnelykke, K, Jaddoe, VWV, Tiemeier, H, Jarvelin, M-R, Evans, DM, Perry, JRB, Grant, SFA, Boomsma, DI, Freathy, RM, McCarthy, MI, Felix, JF, Middeldorp, CM, Mahajan, A, Horikoshi, M, Robertson, NR, Beaumont, RN, Bradfield, JP, Bustamante, M, Cousminer, DL, Day, FR, De Silva, NM, Guxens, M, Mook-Kanamori, DO, St Pourcain, B, Warrington, NM, Adair, LS, Ahlqvist, E, Ahluwalia, TS, Almgren, P, Ang, W, Atalay, M, Auvinen, J, Bartels, M, Beckmann, JS, Bilbao, JR, Bond, T, Borja, JB, Cavadino, A, Charoen, P, Chen, Z, Coin, L, Cooper, C, Curtin, JA, Custovic, A, Das, S, Davies, GE, Dedoussis, GV, Duijts, L, Eastwood, PR, Eliasen, AU, Elliott, P, Eriksson, JG, Estivill, X, Fadista, J, Fedko, IO, Frayling, TM, Gaillard, R, Gauderman, WJ, Geller, F, Gilliland, F, Gilsanz, V, Granell, R, Grarup, N, Groop, L, Hadley, D, Hakonarson, H, Hansen, T, Hartman, CA, Hattersley, AT, Hayes, MG, Hebebrand, J, Heinrich, J, Helgeland, O, Henders, AK, Henderson, J, Henriksen, TB, Hirschhorn, JN, Hivert, M-F, Hocher, B, Holloway, JW, Holt, P, Hottenga, J-J, Hypponen, E, Iniguez, C, Johansson, S, Jugessur, A, Kahonen, M, Kalkwarf, HJ, Kaprio, J, Karhunen, V, Kemp, JP, Kerkhof, M, Koppelman, GH, Korner, A, Kotecha, S, Kreiner-Moller, E, Kulohoma, B, Kumar, A, Kutalik, Z, Lahti, J, Lappe, JM, Larsson, H, Lehtimaki, T, Lewin, AM, Li, J, Lichtenstein, P, Lindgren, CM, Lindi, V, Linneberg, A, Liu, X, Liu, J, Lowe, WL, Lundstrom, S, Lyytikainen, L-P, Ma, RCW, Mace, A, Magi, R, Magnus, P, Mamun, AA, Mannikko, M, Martin, NG, Mbarek, H, McCarthy, NS, Medland, SE, Melbye, M, Melen, E, Mohlke, KL, Monnereau, C, Morgen, CS, Morris, AP, Murray, JC, Myhre, R, Najman, JM, Nivard, MG, Nohr, EA, Nolte, IM, Ntalla, I, O'Reilly, P, Oberfield, SE, Oken, E, Oldehinkel, AJ, Pahkala, K, Palviainen, T, Panoutsopoulou, K, Pedersen, O, Pennell, CE, Pershagen, G, Pitkanen, N, Plomin, R, Power, C, Prasad, RB, Prokopenko, I, Pulkkinen, L, Raikkonen, K, Raitakari, OT, Reynolds, RM, Richmond, RC, Rivadeneira, F, Rodriguez, A, Rose, RJ, Salem, R, Santa-Marina, L, Saw, S-M, Schnurr, TM, Scott, JG, Selzam, S, Shepherd, JA, Simpson, A, Skotte, L, Sleiman, PMA, Snieder, H, Sorensen, TIA, Standl, M, Steegers, EAP, Strachan, DP, Straker, L, Strandberg, T, Taylor, M, Teo, Y-Y, Thiering, E, Torrent, M, Tyrrell, J, Uitterlinden, AG, van Beijsterveldt, T, van der Most, PJ, van Duijn, CM, Viikari, J, Vilor-Tejedor, N, Vogelezang, S, Vonk, JM, Vrijkotte, TGM, Vuoksimaa, E, Wang, CA, Watkins, WJ, Wichmann, H-E, Willemsen, G, Williams, GM, Wilson, JF, Wray, NR, Xu, S, Xu, C-J, Yaghootkar, H, Yi, L, Zafarmand, MH, Zeggini, E, Zemel, BS, Hinney, A, Lakka, TA, Whitehouse, AJO, Sunyer, J, Widen, EE, Feenstra, B, Sebert, S, Jacobsson, B, Njolstad, PR, Stoltenberg, C, Smith, GD, Lawlor, DA, Paternoster, L, Timpson, NJ, Ong, KK, Bisgaard, H, Bonnelykke, K, Jaddoe, VWV, Tiemeier, H, Jarvelin, M-R, Evans, DM, Perry, JRB, Grant, SFA, Boomsma, DI, Freathy, RM, McCarthy, MI, and Felix, JF

Abstract

The impact of many unfavorable childhood traits or diseases, such as low birth weight and mental disorders, is not limited to childhood and adolescence, as they are also associated with poor outcomes in adulthood, such as cardiovascular disease. Insight into the genetic etiology of childhood and adolescent traits and disorders may therefore provide new perspectives, not only on how to improve wellbeing during childhood, but also how to prevent later adverse outcomes. To achieve the sample sizes required for genetic research, the Early Growth Genetics (EGG) and EArly Genetics and Lifecourse Epidemiology (EAGLE) consortia were established. The majority of the participating cohorts are longitudinal population-based samples, but other cohorts with data on early childhood phenotypes are also involved. Cohorts often have a broad focus and collect(ed) data on various somatic and psychiatric traits as well as environmental factors. Genetic variants have been successfully identified for multiple traits, for example, birth weight, atopic dermatitis, childhood BMI, allergic sensitization, and pubertal growth. Furthermore, the results have shown that genetic factors also partly underlie the association with adult traits. As sample sizes are still increasing, it is expected that future analyses will identify additional variants. This, in combination with the development of innovative statistical methods, will provide detailed insight on the mechanisms underlying the transition from childhood to adult disorders. Both consortia welcome new collaborations. Policies and contact details are available from the corresponding authors of this manuscript and/or the consortium websites.

Published
2019

15. Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste

Author

Nery, SV, Qi, J, Llewellyn, S, Clarke, NE, Traub, R, Gray, DJ, Vallely, AJ, Williams, GM, Andrews, RM, McCarthy, JS, Clements, ACA, Nery, SV, Qi, J, Llewellyn, S, Clarke, NE, Traub, R, Gray, DJ, Vallely, AJ, Williams, GM, Andrews, RM, McCarthy, JS, and Clements, ACA

Abstract

BACKGROUND: Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification. RESULTS: A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10-14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9-95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3-100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4-64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0-97.0%). CONCLUSIONS: The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic w

Published
2018

16. Investigations into the association between soil-transmitted helminth infections, haemoglobin and child development indices in Manufahi District, Timor-Leste

Author

Campbell, SJ, Nery, SV, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, Clements, ACA, Campbell, SJ, Nery, SV, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, and Clements, ACA

Abstract

© 2017 The Author(s). Background: Timor-Leste has a high prevalence of soil-transmitted helminth (STH) infections. High proportions of the population have been reported as being anaemic, and extremely high proportions of children as stunted or wasted. There have been no published analyses of the contributions of STH to these morbidity outcomes in Timor-Leste. Methods: Using baseline cross-sectional data from 24 communities (18 communities enrolled in a cluster randomised controlled trial, and identically-collected data from six additional communities), analyses of the association between STH infections and community haemoglobin and child development indices were undertaken. Stool samples were assessed for STH using qPCR and participant haemoglobin, heights and weights were measured. Questionnaires were administered to collect demographic and socioeconomic data. Intensity of infection was categorised using correlational analysis between qPCR quantification cycle values and eggs per gram of faeces equivalents, with algorithms generated from seeding experiments. Mixed-effects logistic and multinomial regression were used to assess the association between STH infection intensity classes and anaemia, and child stunting, wasting and underweight. Results: Very high stunting (60%), underweight (60%), and wasting (20%) in children, but low anaemia prevalence (15%), were found in the study communities. STH were not significantly associated with morbidity outcomes. Male children and those in the poorest socioeconomic quintile were significantly more likely to be moderately and severely stunted. Male children were significantly more likely than female children to be severely underweight. Increasing age was also a risk factor for being underweight. Few risk factors emerged for wasting in these analyses. Conclusions: According to World Health Organization international reference standards, levels of child morbidity in this population constitute a public health emergency, although

Published
2017

17. Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR

Author

Campbell, SJ, Nery, SV, Wardell, R, D Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, Clements, ACA, Campbell, SJ, Nery, SV, Wardell, R, D Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, and Clements, ACA

Abstract

© 2017 Campbell et al. Background: No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste. Methods: A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection. Results: 2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9–19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1–14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0–4.3; heavy-intensity ARR 2.7; 95% CI 1.6–4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09–0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01–0.25). Few WASH risk factors were significant. Conclusion: In this high-prevalence setting, strong risk associ

Published
2017

18. Water, Sanitation and Hygiene (WASH) and environmental risk factors for soil-transmitted helminth intensity of infection in Timor-Leste, using real time PCR

Author

Bethony, JM, Campbell, SJ, Nery, SV, Wardell, R, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, Clements, ACA, Bethony, JM, Campbell, SJ, Nery, SV, Wardell, R, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, and Clements, ACA

Abstract

BACKGROUND: No investigations have been undertaken of risk factors for intensity of soil-transmitted helminth (STH) infection in Timor-Leste. This study provides the first analysis of risk factors for intensity of STH infection, as determined by quantitative PCR (qPCR), examining a broad range of water, sanitation and hygiene (WASH) and environmental factors, among communities in Manufahi District, Timor-Leste. METHODS: A baseline cross-sectional survey of 18 communities was undertaken as part of a cluster randomised controlled trial, with additional identically-collected data from six other communities. qPCR was used to assess STH infection from stool samples, and questionnaires administered to collect WASH, demographic, and socioeconomic data. Environmental information was obtained from open-access sources and linked to infection outcomes. Mixed-effects multinomial logistic regression was undertaken to assess risk factors for intensity of Necator americanus and Ascaris infection. RESULTS: 2152 participants provided stool and questionnaire information for this analysis. In adjusted models incorporating WASH, demographic and environmental variables, environmental variables were generally associated with infection intensity for both N. americanus and Ascaris spp. Precipitation (in centimetres) was associated with increased risk of moderate-intensity (adjusted relative risk [ARR] 6.1; 95% confidence interval [CI] 1.9-19.3) and heavy-intensity (ARR 6.6; 95% CI 3.1-14.1) N. americanus infection, as was sandy-loam soil around households (moderate-intensity ARR 2.1; 95% CI 1.0-4.3; heavy-intensity ARR 2.7; 95% CI 1.6-4.5; compared to no infection). For Ascaris, alkaline soil around the household was associated with reduced risk of moderate-intensity infection (ARR 0.21; 95% CI 0.09-0.51), and heavy-intensity infection (ARR 0.04; 95% CI 0.01-0.25). Few WASH risk factors were significant. CONCLUSION: In this high-prevalence setting, strong risk associations with environment

Published
2017

19. Water, sanitation and hygiene related risk factors for soil-transmitted helminth and Giardia duodenalis infections in rural communities in Timor-Leste

Author

Campbell, SJ, Nery, SV, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, Amaral, S, Clements, ACA, Campbell, SJ, Nery, SV, D'Este, CA, Gray, DJ, McCarthy, JS, Traub, RJ, Andrews, RM, Llewellyn, S, Vallely, AJ, Williams, GM, Amaral, S, and Clements, ACA

Abstract

There is little evidence on prevalence or risk factors for soil transmitted helminth infections in Timor-Leste. This study describes the epidemiology, water, sanitation and hygiene, and socioeconomic risk factors of STH and intestinal protozoa amongst communities in Manufahi District, Timor-Leste. As part of a cluster randomised controlled trial, a baseline cross-sectional survey was conducted across 18 villages, with data from six additional villages. Stool samples were assessed for soil transmitted helminth and protozoal infections using quantitative PCR (qPCR) and questionnaires administered to collect water, sanitation and hygiene and socioeconomic data. Risk factors for infection were assessed using multivariable mixed-effects logistic regression, stratified by age group (preschool, school-aged and adult). Overall, soil transmitted helminth prevalence was 69% (95% Confidence Interval 67–71%), with Necator americanus being most common (60%; 95% Confidence Interval 58–62%) followed by Ascaris spp. (24%; 95% Confidence Interval 23–26%). Ascaris-N. americanus co-infection was common (17%; 95% Confidence Interval 15%-18%). Giardia duodenalis was the main protozoan identified (13%; 95% Confidence Interval 11–14%). Baseline water, sanitation and hygiene infrastructure and behaviours were poor. Although risk factors varied by age of participants and parasite species, risk factors for N. americanus infection included, generally, age in years, male sex, and socioeconomic quintile. Risk factors for Ascaris included age in years for children, and piped water to the yard for adults. In this first known assessment of community-based prevalence and associated risk factors in Timor-Leste, soil transmitted helminth infections were highly prevalent, indicating a need for soil transmitted helminth control. Few associations with water, sanitation and hygiene were evident, despite water, sanitation and hygiene being generally poor. In our water, sanitation and hygiene we will inves

Published
2016

20. Low-intensity case management increases contact with primary care in recently released prisoners: a single-blinded, multisite, randomised controlled trial

Author

Kinner, SA, Alati, R, Longo, M, Spittal, MJ, Boyle, FM, Williams, GM, Lennox, NG, Kinner, SA, Alati, R, Longo, M, Spittal, MJ, Boyle, FM, Williams, GM, and Lennox, NG

Abstract

BACKGROUND: The world prison population is large and growing. Poor health outcomes after release from prison are common, but few programmes to improve health outcomes for ex-prisoners have been rigorously evaluated. The aim of this study was to evaluate the impact of individualised case management on contact with health services during the first 6 months post-release. METHODS: Single-blinded, randomised, controlled trial. Baseline assessment with N=1325 adult prisoners in Queensland, Australia, within 6 weeks of expected release; follow-up interviews 1, 3 and 6 months post-release. The intervention consisted of provision of a personalised booklet ('Passport') at the time of release, plus up to four brief telephone contacts in the first 4 weeks post-release. RESULTS: Of 1179 eligible participants, 1003 (85%) completed ≥1 follow-up interview. In intention-to-treat analyses, 53% of the intervention group and 41% of the control group reported contacting a general practitioner (GP) at 1 month post-release (difference=12%, 95% CI 5% to 19%). Similar effects were observed for GP contact at 3 months (difference=9%, 95% CI 2% to 16%) and 6 months (difference=8%, 95% CI 1% to 15%), and for mental health (MH) service contact at 6 months post release (difference=8%, 95% CI 3% to 14%). CONCLUSIONS: Individualised case management in the month after release from prison increases usage of primary care and MH services in adult ex-prisoners for at least 6 months post-release. Given the poor health profile of ex-prisoners, there remains an urgent need to develop and rigorously evaluate interventions to increase health service contact in this profoundly marginalised population. TRIAL REGISTRATION NUMBER: ACTRN12608000232336.

Published
2016

22. [Untitled]

Author

Williams Gm

Subjects
Chemical compound, Health, Toxicology and Mutagenesis, Liver cell, Cell Biology, Biology, Toxicology, medicine.disease_cause, In vitro, chemistry.chemical_compound, medicine.anatomical_structure, Biochemistry, chemistry, Cell culture, Hepatocyte, Toxicity, medicine, Genotoxicity, DNA
Abstract

Liver culture systems, both primary cultures of hepatocytes and replicating cell lines, can be used in a variety of ways to study the DNA-damaging effects of chemicals and radiation. The present report describes some of the available methods and their interpretation.

Published
1997
Full Text
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23. Identification of key residues involved in adrenomedullin binding to the AM 1 receptor

Author

Watkins, HA, Au, M, Hay, DL, Bobby, R, Archbold, JK, Abdul-Manan, N, Moore, JM, Middleditch, MJ, Williams, GM, Brimble, MA, and Dingley, Andrew

Subjects
ddc:610
Abstract

BACKGROUND AND PURPOSE:Adrenomedullin (AM) is a peptide hormone whose receptors are members of the class B GPCR family. They comprise a heteromer between the GPCR, the calcitonin receptor-like receptor and one of the receptor activity-modifying proteins 1-3. AM plays a significant role in angiogenesis and its antagonist fragment AM22-52 can inhibit blood vessel and tumour growth. The mechanism by which AM interacts with its receptors is unknown.EXPERIMENTAL APPROACH:We determined the AM22-52 binding epitope for the AM1 receptor extracellular domain using biophysical techniques, heteronuclear magnetic resonance spectroscopy and alanine scanning.KEY RESULTS:Chemical shift perturbation experiments located the main binding epitope for AM22-52 at the AM1 receptor to the C-terminal 8 amino acids. Isothermal titration calorimetry of AM22-52 alanine-substituted peptides indicated that Y52, G51 and I47 are essential for AM1 receptor binding and that K46 and P49 and R44 have a smaller role to play. Characterization of these peptides at the full-length AM receptors was assessed in Cos7 cells by cAMP assay. This confirmed the essential role of Y52, G51 and I47 in binding to the AM1 receptor, with their substitution resulting in ≥100-fold reduction in antagonist potency compared with AM22-52 . R44A, K46A, S48A and P49A AM22-52 decreased antagonist potency by approximately 10-fold.CONCLUSIONS AND IMPLICATIONS:This study localizes the main binding epitope of AM22-52 to its C-terminal amino acids and distinguishes essential residues involved in this binding. This will inform the development of improved AM receptor antagonists.

Published
2013
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24. Interventive prophylaxis of liver cancer

Author

Williams Gm

Subjects
Cancer Research, medicine.medical_specialty, Epidemiology, business.industry, Liver Neoplasms, Public Health, Environmental and Occupational Health, Cancer, Antineoplastic Agents, medicine.disease, Intervention studies, Rats, Surgery, Mice, Animal model, Oncology, medicine, Animals, Anticarcinogenic Agents, Liver cancer, business, Intensive care medicine, Anticarcinogen
Abstract

About 30 agents have been shown to diminish liver cancer in experimental animals. For many of these, safety is well established, thus permitting intervention studies, and some agents are already being used in trials for anticarcinogenesis at other sites. An aspect that has received little attention and warrants further study is combination cancer prophylaxis.

Published
1994
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25. Water, Sanitation, and Hygiene (WASH): A Critical Component for Sustainable Soil-Transmitted Helminth and Schistosomiasis Control

Author

Zhou, X-N, Campbell, SJ, Savage, GB, Gray, DJ, Atkinson, J-AM, Magalhaes, RJS, Nery, SV, McCarthy, JS, Velleman, Y, Wicken, JH, Traub, RJ, Williams, GM, Andrews, RM, Clements, ACA, Zhou, X-N, Campbell, SJ, Savage, GB, Gray, DJ, Atkinson, J-AM, Magalhaes, RJS, Nery, SV, McCarthy, JS, Velleman, Y, Wicken, JH, Traub, RJ, Williams, GM, Andrews, RM, and Clements, ACA

Published
2014

26. Randomised controlled trial of a service brokerage intervention for ex-prisoners in Australia

Author

Kinner, SA, Lennox, N, Williams, GM, Carroll, M, Quinn, B, Boyle, FM, Alati, R, Kinner, SA, Lennox, N, Williams, GM, Carroll, M, Quinn, B, Boyle, FM, and Alati, R

Abstract

BACKGROUND: Health outcomes after release from prison are typically poor with elevated rates of morbidity and mortality widely documented. Under-utilisation of health services contributes to these outcomes, but interventions to increase health service utilisation in ex-prisoners are in their infancy and few have been rigorously evaluated. METHODS: Single-blinded randomised controlled trial of a service brokerage intervention (the 'Passports study') for N = 1325 adult ex-prisoners in Queensland, Australia. Participants in the intervention group received a personalised booklet summarising their health status and identifying appropriate community health services; trained workers made weekly telephone contact in the first 4 weeks post-release to identify health needs and facilitate health service utilisation. Participants in the control arm received usual care. Baseline data were collected within 6 weeks of expected release from custody with follow-up telephone interviews 1, 3 and 6 months post-release. Participant identities were linked with federal health service utilisation records, a national death register and corrective services records, two years post-release. The primary outcome was self-reported health service utilisation in the first 6 months post-release. RESULTS: Between 2008 and 2010 1976 prisoners were screened for eligibility, 1665 met eligibility criteria and 1325 were recruited; 665 were randomised to the intervention and 660 to the control condition. Participants were broadly representative of adults being released from prison in Queensland except that women were intentionally oversampled (21% vs. 11%). CONCLUSIONS: Outcomes from this large RCT will provide the first robust evidence of the effect of service brokerage on health service utilisation and health outcomes for ex-prisoners.

Published
2013

28. An investigation of some sediment-filled fractures within redbed sandstones of the UK

Author

Hough, Edward, Pearce, Jonathan, Kemp, Simon, Williams, GM, Hough, Edward, Pearce, Jonathan, Kemp, Simon, and Williams, GM

Abstract

Permo-Triassic sandstones form the most important aquifer in northern England. These sandstones are susceptible to contamination from a legacy of industrial development, associated with the expansion of urban areas that include Liverpool, Manchester, Birmingham, Nottingham and Teesside. The permeability of the sandstone is derived from the intergranular pore spaces and fractures. However, unconsolidated sediment found within fractures can have a profound effect on fluid flow, depending on whether it is clay or sand. Sediment-filled fractures are not well described in the literature; consequently there are few observations or measurements of the hydraulic properties of these features that would enable an assessment to be made of their hydrogeological significance, and it is unclear how they should be included in solute transport models. A field survey was undertaken to test whether sediment-filled fractures are a common feature within redbed sandstone terrains. Exposures from most of the main UK Permo-Triassic sedimentary basins, and some from the Devonian Old Red Sandstone in south Wales, were examined. The field survey, which included surface and underground tunnel exposures, enabled the investigation of both unweathered and weathered examples of sediment-filled fractures. Detailed mineralogical and petrographical analysis of fracture fills and host rock indicate that, in some cases, fills are historic, and that there is a component to some fills that indicates a glacial origin. Where the fill is unconsolidated, sediment may be flushed from fractures; this may explain why some water wells abstracting from the Permo-Triassic sandstones of the UK pump large quantities of sand throughout their active life, and this may be a contributory factor to the observation that transmissivity around abstraction wells in sandstone can increase with time. It is likely that, in certain circumstances, sediment-filled fractures may locally alter fluid migration paths through sandston

Published
2006

31. Induction of proliferative lesions of ventral prostate, seminal vesicle, and other accessory sex glands in rats by N-methyl-N-nitrosourea: effect of castration, pretreatment with cyproterone acetate and testosterone propionate and rat strain

Author

Weisburger Jh, Prinsen Mk, Rivenson A, Maarten C. Bosland, Kroes R, Emerich S. Fiala, Williams Gm, and Silverman J

Subjects
Testosterone propionate, DNA Replication, Male, medicine.medical_specialty, Time Factors, medicine.drug_class, Urology, chemistry.chemical_compound, Seminal vesicle, Prostate, Internal medicine, Testis, medicine, Animals, Testosterone, Orchiectomy, Cyproterone, Cyproterone Acetate, business.industry, Cyproterone acetate, Prostatic Neoplasms, Seminal Vesicles, Methylnitrosourea, Rats, Inbred Strains, DNA, Neoplasm, Androgen, Rats, Inbred F344, Rats, medicine.anatomical_structure, Endocrinology, Castration, Oncology, chemistry, Androgens, Genital Neoplasms, Male, business, medicine.drug
Abstract

Wistar (Cpb:WU), F344 or Sprague-Dawley rats were sequentially treated with cyproterone acetate (CA) for 21 days, testosterone propionate (TP) for 3 days, followed by a single i.v. injection of N-methyl-N-nitrosourea (MNU). One group of Wistar rats was castrated 4 weeks after MNU injection, and another group 58 weeks after MNU, when the first prostatic carcinoma was detected. Control groups received only CA + TP, CA, MNU, or they remained untreated. Early or late castration inhibited the development of atypical hyperplasia of the ventral prostate in Wistar rats. This lesion was induced by the CA + TP + MNU treatment in F344 rats, but not Sprague-Dawley rats; in Wistar rats, it was induced by CA + TP treatment, irrespective of whether MNU was given. Hypertrophic-hyperplastic lesions of the seminal vesicle were induced by MNU, irrespective of pretreatment, and their development was prevented by early castration and inhibited by late orchiectomy. Dorsolateral prostate carcinomas and preneoplasia occurred only in low incidence in Wistar and Sprague-Dawley rats. These lesions were absent in F344 rats that had received treatment with CA + TP + MNU. No dorsolateral prostate (pre)neoplasia was found in Wistar rats subjected to early orchiectomy, but rats castrated at 58 weeks had an incidence similar to that for the intact group treated with CA + TP + MNU. This finding supports the contention that androgens are required for the development of MNU-induced prostatic cancer in rats but that advanced carcinomas are androgen insensitive. Differences in incidence and localization of prostatic proliferative lesions between F344 and Wistar rats and between dorsolateral and ventral prostate could not be explained by differences in epithelial cell proliferative responses to CA + TP treatment at the time of MNU injection, since they were similar in ventral and dorsolateral prostate and were more prominent in F344 rats than in Wistar rats. DNA damage as estimated by MNU-induced unscheduled DNA synthesis also did not differ between dorsolateral and ventral prostate.

Published
1992

32. [82] Quantitation of free radical-mediated reperfusion injury in renal transplantation

Author

Williams Gm

Subjects
medicine.medical_specialty, Kidney, Creatinine, biology, business.industry, medicine.medical_treatment, Urology, Ischemia, Renal function, medicine.disease, Transplantation, Superoxide dismutase, chemistry.chemical_compound, medicine.anatomical_structure, chemistry, medicine, biology.protein, business, Reperfusion injury, Dialysis
Abstract

Publisher Summary This chapter discusses the quantitation of free radical-mediated reperfusion injury in renal transplantation. Schneeberger reported on 100 cadaver donor kidneys in which one of the pair of kidneys was treated with superoxide dismutase (SOD) at reperfusion. The study was randomized and double-blinded. Considering the data overall, there were no significant differences in the function of SOD-and placebo-treated kidneys. However, more detailed analysis of the pairs revealed that SOD-treated kidneys had double the creatinine clearance at days 2 and 7, and the time for serum creatinine to fall without dialysis was reduced from 8 to 4 days. Because of small numbers, these differences did not prove to be statistically significant. Considering the function of the second of the two kidneys of a pair transplanted, by selecting kidneys that were ischemic in the cold for longer periods of time, more dramatic improvement was noted in all parameters in test kidneys, but the differences still fell short of statistical significance. Thus, there is no conclusive data in humans documenting a window of reperfusion damage. However, the existing data are encouraging enough to promote two larger studies.

Published
1990
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42. Identification of key residues involved in adrenomedullin binding to the AM1 receptor.

Author

Watkins, HA, Au, M, Bobby, R, Archbold, JK, Abdul‐Manan, N, Moore, JM, Middleditch, MJ, Williams, GM, Brimble, MA, Dingley, AJ, and Hay, DL

Subjects
ADRENOMEDULLIN, G protein coupled receptors, NUCLEAR magnetic resonance, CALORIMETRY, LIGANDS (Biochemistry)
Abstract

Background and Purpose Adrenomedullin ( AM) is a peptide hormone whose receptors are members of the class B GPCR family. They comprise a heteromer between the GPCR, the calcitonin receptor-like receptor and one of the receptor activity-modifying proteins 1-3. AM plays a significant role in angiogenesis and its antagonist fragment AM22-52 can inhibit blood vessel and tumour growth. The mechanism by which AM interacts with its receptors is unknown. Experimental Approach We determined the AM22-52 binding epitope for the AM1 receptor extracellular domain using biophysical techniques, heteronuclear magnetic resonance spectroscopy and alanine scanning. Key Results Chemical shift perturbation experiments located the main binding epitope for AM22-52 at the AM1 receptor to the C-terminal 8 amino acids. Isothermal titration calorimetry of AM22-52 alanine-substituted peptides indicated that Y52, G51 and I47 are essential for AM1 receptor binding and that K46 and P49 and R44 have a smaller role to play. Characterization of these peptides at the full-length AM receptors was assessed in Cos7 cells by cAMP assay. This confirmed the essential role of Y52, G51 and I47 in binding to the AM1 receptor, with their substitution resulting in ≥100-fold reduction in antagonist potency compared with AM22-52. R44A, K46A, S48A and P49A AM22-52 decreased antagonist potency by approximately 10-fold. Conclusions and Implications This study localizes the main binding epitope of AM22-52 to its C-terminal amino acids and distinguishes essential residues involved in this binding. This will inform the development of improved AM receptor antagonists. [ABSTRACT FROM AUTHOR]

Published
2013
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43. Associations of duration, intensity, and quantity of smoking with adenocarcinoma and squamous cell carcinoma of the esophagus.

Author

Pandeya N, Williams GM, Sadhegi S, Green AC, Webb PM, and Whiteman DC

Abstract

Smoking has been identified as a risk factor for esophageal cancer; however, there is evidence that magnitudes and patterns of association differ by histologic type. The authors aimed to measure and compare the independent effects of various dimensions of smoking (duration, intensity, total dose, and time since quitting) on risks of esophageal adenocarcinoma (EAC), gastroesophageal junction adenocarcinoma (GEJAC), and esophageal squamous cell carcinoma (ESCC). They used data from a population-based Australian case-control study (2002-2005) comprising 367 EAC cases, 426 GEJAC cases, and 309 ESCC cases and 1,580 controls. Multivariate logistic and generalized additive logistic regression (for nonlinear dose effects) were used. Ever smokers had significantly higher risks of EAC (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.3, 2.3), GEJAC (OR = 2.4, 95% CI: 1.8, 3.2), and ESCC (OR = 2.8, 95% CI: 2.0, 4.0) than did never smokers; however, there were significant differences in magnitude and patterns of association between subtypes. When multiple dimensions of smoking were assessed concurrently, duration was significantly associated with all three subtypes but intensity was associated only with GEJAC and ESCC, and the associations were nonlinear. For all types of esophageal cancer, time since quitting was independently associated with approximately 15-19% risk reductions per decade. [ABSTRACT FROM AUTHOR]

Published
2008
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45. The association of hypertensive disorders of pregnancy with weight gain over the subsequent 21 years: findings from a prospective cohort study.

Author

Callaway LK, McIntyre HD, O'Callaghan M, Williams GM, Najman JM, and Lawlor DA

Abstract

Obesity is an important risk factor for hypertensive disorders of pregnancy, but most cases of hypertensive disorders of pregnancy occur in women of normal weight. There may be predisposing factors to both hypertensive disorders of pregnancy and obesity. To test this hypothesis, the authors compared changes in body mass index (weight (kg)/height (m)2) over time in women with and without hypertensive disorders of pregnancy. They used data from 3,572 women who received antenatal care at a major public hospital in Brisbane, Australia, between 1981 and 1984 and who were followed up for 21 years. A total of 318 women (8.9%) had experienced hypertensive disorders in the index pregnancy, and 233 of them (73.3%) had a baseline body mass index of or=5 kg/m2 were 59% greater for women who experienced hypertensive disorders of pregnancy compared with those who did not (odds ratio=1.59, 95% confidence interval: 1.24, 2.04). The authors concluded that hypertensive disorders of pregnancy are associated with increased weight gain over 21 years. [ABSTRACT FROM AUTHOR]

Published
2007
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46. Is there a fetal origin of depression? Evidence from the Mater University Study of Pregnancy and its outcomes.

Author

Alati R, Lawlor DA, Mamun AA, Williams GM, Najman JM, O'Callaghan M, and Bor W

Abstract

It is unclear whether there is a fetal origin of adult depression. In particular, previous studies have been unable to adjust for the potential effect of maternal depression during pregnancy on any association. The association of birth weight with adult symptoms of depression was examined in an Australian prospective birth cohort, the Mater University Study of Pregnancy and its outcomes. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale among 3,719 participants at the 21-year follow-up in 2002-2005. In multivariable analyses, there were a weak inverse association between birth weight and symptoms of depression in the whole cohort and some evidence of sex differences in this association. Among females, there was a graded inverse association: In the fully adjusted model, the odds ratio for a high level of depressive symptoms for a 1-standard deviation increase in birth weight (gestational age-standardized z score) was 0.82 (95% confidence interval: 0.73, 0.92). Among males, there was no association (with sex in all models: p(interaction) < 0.004). Study results provide some support for a fetal origin of adult depression and suggest that the association is not explained by maternal mental health characteristics during pregnancy. Further research is needed to better understand the mechanisms underlying the association. [ABSTRACT FROM AUTHOR]

Published
2007

47. Epidemiologic evidence for the fetal overnutrition hypothesis: findings from the Mater-University Study of Pregnancy and Its Outcomes.

Author

Lawlor DA, Smith GD, O'Callaghan M, Alati R, Mamun AA, Williams GM, and Najman JM

Abstract

The fetal overnutrition hypothesis proposes that greater maternal adiposity results in increased obesity throughout life in the offspring. The authors examined the associations between parental prepregnancy body mass index (BMI; weight (kg)/height (m)(2)), based on height and weight reported by the mother at her first antenatal clinic visit, and offspring BMI (height and weight measured at age 14 years) in 3,340 parent-offspring trios from a birth cohort based in Brisbane, Australia (mothers were recruited in 1981-1984). The maternal-offspring BMI association was stronger than the paternal-offspring BMI association. In the fully adjusted model, the increase in standardized offspring BMI at age 14 for a one-standard-deviation (SD) increase in maternal BMI was 0.362 SD (95% confidence interval: 0.323, 0.402), and the corresponding result for a one-SD increase in paternal BMI was 0.239 SD (95% confidence interval: 0.197, 0.282). There was statistical support for a difference in the magnitude of the association between maternal-offspring BMI and paternal-offspring BMI in all confounder-adjusted models tested (all p's < 0.0001). In sensitivity analyses taking account of different plausible levels of nonpaternity (up to 15%), the greater maternal effect remained. These findings provide some support for the fetal overnutrition hypothesis. [ABSTRACT FROM AUTHOR]

Published
2007

48. Correcting for numerator/denominator bias when assessing changing inequalities in occupational class mortality, Australia 1981-2002.

Author

Williams GM, Najman JM, and Clavarino A

Abstract

OBJECTIVE: Comparisons of the changing patterns of inequalities in occupational mortality provide one way to monitor the achievement of equity goals. However, previous comparisons have not corrected for numerator/denominator bias, which is a consequence of the different ways in which occupational details are recorded on death certificates and on census forms. The objective of this study was to measure the impact of this bias on mortality rates and ratios over time. METHODS: Using data provided by the Australian Bureau of Statistics, we examined the evidence for bias over the period 1981 -2002, and used imputation methods to adjust for this bias. We compared unadjusted with imputed rates of mortality for manual/non-manual workers. FINDINGS: Unadjusted data indicate increasing inequality in the age-adjusted rates of mortality for manual/non-manual workers during 1981 -2002. Imputed data suggest that there have been modest fluctuations in the ratios of mortality for manual/non-manual workers during this time, but with evidence that inequalities have increased only in recent years and are now at historic highs. CONCLUSION: We found that imputation for missing data leads to changes in estimates of inequalities related to social class in mortality for some years but not for others. Occupational class comparisons should be imputed or otherwise adjusted for missing data on census or death certificates. Copyright © 2006 World Health Organization [ABSTRACT FROM AUTHOR]

Published
2006
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49. Long-term increase in a sunscreen use in an Australian community after a skin cancer prevention trial.

Author

van der Pols JC, Williams GM, Neale RE, Clavarino A, and Green AC

Abstract

BACKGROUND: Given the public health burden of skin cancer in white populations, an increase in sun protective behavior is needed. In a high-risk community, we assessed long-term sunscreen use among people who had participated in a randomized trial of daily sunscreen application for prevention of skin cancer. METHODS: In 1992, 1621 residents of the subtropical Australian township of Nambour were randomly allocated to either daily or discretionary sunscreen use until 1996. From 1997 to 2002, we monitored by questionnaires their ongoing sunscreen use. RESULTS: People who had never or irregularly used sunscreen when in summer sun before the trial were more likely (P < 0.0001) to be sustaining regular application especially to their face (20% vs. 11%) and forearms (14% vs. 5%) if they had been allocated to daily, not discretionary, use of sunscreen for 5 years. CONCLUSIONS: Regular voluntary sunscreen use for skin cancer prevention can be sustained by sun-sensitive people in the long term. Habit formation appears to be an important goal for sun protection programs among those living, or on vacation, in sunny places. Copyright © 2006 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Published
2006
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