Evaluation of BSP expression and apoptosis in the periodontal ligament during orthodontic relapse: a preliminary study

OBJECTIVE

To examine the expression of bone sialoprotein (BSP) and apoptosis in an in vivo orthodontic relapse model.

MATERIALS AND METHODS

Male mice (10-12 weeks old), either transgenic [green fluorescent protein (GFP) driven by the BSP promoter] or wild type, were used in this study. To achieve orthodontic tooth movement (OTM), maxillary right first molars were moved mesially using closed-coil springs. Animals were divided into an OTM group (14 days continuous orthodontic force - 11 animals) or Relapse group (10 days of force application followed by 4 days of relapse - 8 animals). The control group was comprised of the contralateral maxillary molars. The periodontal ligament (PDL) was analyzed in areas of compression and tension for transgenic expression, osteoclast localization, and the presence of apoptotic cells.

RESULTS

There was a significant decrease in GFP-labeled cells on the compression and tension sides of the PDL in the OTM group compared with control. In the relapse group, GFP-labeled cells were significantly decreased only on the old compression side. Osteoclasts were localized on the compression side of the OTM group, whereas in the Relapse group, they were present on both sides. PDL apoptosis significantly increased on the compression side in OTM and Relapse groups.

CONCLUSION

Both OTM and Relapse groups exhibited a decreased number of GFP-labeled cells in areas of compression and tension. There was significant PDL apoptosis in regions under compressive forces following OTM and to a lesser extent following relapse.

Development and validation of a clinical decision-making aid for screening bowel symptoms in community pharmacies

RATIONALE, AIMS AND OBJECTIVES

Bowel symptoms are common, and community pharmacies are an ideal setting for health advice about these symptoms. The aim of this study was to develop and validate a questionnaire for use with adults presenting to community pharmacies with lower bowel symptoms. The purpose of the questionnaire was to stratify people into those requiring medical follow-up for symptoms and those with self-limiting symptoms.

METHOD

A self-administered questionnaire, named the Jodi Lee test (JLT), was developed in three stages - review of the literature, questionnaire design and statistical validation - against a validated screening tool, the patient consultation questionnaire (PCQ), to assess the sensitivity and specificity of JLT. The questionnaire was developed to be simple, easy for all pharmacy staff to use and require no score calculation. Its application was designed to facilitate referral from pharmacy assistants to pharmacists and from pharmacists to medical practitioners.

RESULTS

The questionnaire comprises eight questions. It has a Flesh-Kincaid reading score of 79.5. By considering different score thresholds on the PCQ, a receiver operator characteristic (ROC) curve was calculated to assess the effectiveness of the JLT. From a sample of 118 subjects, the area under the ROC curve was 0.94. At a threshold score of 30 on the PCQ, the sensitivity was 100%. The specificity was 65%.

CONCLUSION

The JLT has high sensitivity for identifying patients with symptoms of serious bowel disease. It is also likely to identify patients who have symptoms of relatively benign disease who would benefit from medical advice.

Academic and personal problems among Australian university students who drink at hazardous levels: web-based survey

ISSUE ADDRESSED

Australian university students consume large amounts of alcohol. There is little published information about personal and academic problems associated with this behaviour. We sought to estimate the prevalence, and identify variables associated with, alcohol-related problems among undergraduate hazardous drinkers.

METHODS

The control group members (942 undergraduates, 53.3% male, mean age 19.4 years) of an internet-based intervention trial, who scored ≥8 on the Alcohol Use Disorders Identification Test, completed two validated questionnaires about their experience of alcohol-related problems in the preceding 4 weeks. Regression models were used to identify associations between individual characteristics and alcohol-related problems.

RESULTS

One-quarter of participants had missed a class (25.6%) and/or had been unable to concentrate in class (25.7%), and 45% reported that their drinking had impacted negatively on their learning or grades. The most frequent non-academic problems were hangovers (74.8%), blackouts (44.8%), emotional outbursts (30.5%), vomiting (28.1%), arguments (20.2%) and drink-driving (23.2%). Male gender, lower age, being a smoker, being in the Faculty of Health (versus Humanities) and living in shared housing (versus with parents/guardians) were each associated with alcohol-related problems, whereas year of study had no association.

CONCLUSIONS

There is a high prevalence of preventable alcohol-related problems among undergraduates drinking at hazardous levels and a need for restriction of the availability and promotion of alcohol as well as intervention for individuals at high risk. SO WHAT?: Universities have a duty of care to large populations of young people drinking at hazardous levels and should make greater efforts to address hazardous alcohol consumption.

Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders

BACKGROUND

Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs.

METHODS

This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses.

RESULTS

Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services.

CONCLUSIONS

This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.

‘It still leaves me sixty dollars out of pocket’: experiences of diabetes medical care among low-income earners in Perth

Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community.

Development of a patient-administered self-assessment tool (SATp) for follow-up of colorectal cancer patients in general practice

BACKGROUND

Treatment for colorectal cancer (CRC) may result in physical, social, and psychological needs that affect patients' quality of life post-treatment. A comprehensive assessment should be conducted to identify these needs in CRC patients post treatment, however, there is a lack of tools and processes available in general practice.

AIMS

This study aimed to develop a patient-completed needs screening tool that identifies potentially unmet physical, psychological, and social needs in CRC and facilitates consultation with a general practitioner (GP) to address these needs.

METHODS

The development of the self-assessment tool for patients (SATp) included a review of the literature; face and content validity with reference to an expert panel; psychometric testing including readability, internal consistency, and test-retest reliability; and usability in clinical practice.

RESULTS

The SATp contains 25 questions. The tool had internal consistency (Cronbach's alpha 0.70-0.97), readability (reading ease 82.5%), and test-retest reliability (kappa 0.689-1.000). A total of 66 patients piloted the SATp. Participants were on average 69.2 (SD 9.9) years old and had a median follow-up period of 26.7 months. The SATp identified a total of 547 needs (median 7 needs/per patient; IQR [3-12.25]). Needs were categorised into social (175[32%]), psychological (175[32%]), and physical (197[36%]) domains.

CONCLUSION

SATp is a reliable self-assessment tool useful for identifying CRC patient needs. Further testing of this tool for validity and usability is underway.

Colorectal cancer--applying a gender lens

BACKGROUND

Colorectal cancer (CRC) is a major global health problem with survival varying according to stage at diagnosis. The incidence of CRC is much higher in patients with lower bowel symptoms. The symptoms are non-specific and are commonly experienced in the general population. Biological and environmental factors account for the high incidence and poor prognosis of CRC in men.

OBJECTIVE

To review the behavioural factors influencing patient delay in seeking help for lower bowel symptoms using a gender lens.

METHODS

An extensive literature search was performed using various databases including Medline, PubMed, CINAHL Plus, EMBASE and PsycINFO (1993-2013). Various search terms including rectal bleeding, prevalence, colorectal cancer, consultation, help-seeking, gender differences and men were used. A systematic methodology including systematic data extraction and narrative synthesis was applied.

RESULTS

Thirty-two studies were included in the review. All studies except four were quantitative. Although there is some evidence that men delay more compared with women, there has not been any major improvement in the help-seeking behaviour for such symptoms over the past two decades. Several behavioural and demographic factors were associated with low rates of help-seeking.

CONCLUSION

There are limited studies focusing on men's help-seeking behaviour for lower bowel symptoms. To facilitate timely help-seeking in men, it is important to understand their patterns of helpseeking for such symptoms. Further research to understand men's help-seeking behaviour is warranted.

The impact of knowledge, attitudes and beliefs on the engagement of primary and community-based healthcare professionals in cancer care: a literature review

BACKGROUND

Primary health services are well placed to reinforce prevention, early intervention, and connected care. Despite this important role, primary care providers (PCPs) have a limited capacity to meet the varied needs of people with cancer and their carers - furthermore, the reasons for this largely remain unexplored.

SCOPE

To identify: (1) the knowledge, attitudes, and beliefs held by health professionals and patients that can influence the engagement of PCPs with the early detection of cancer and follow-up care; (2) evidence that attitudes and beliefs can be modified with measureable impact on the engagement of PCPs with cancer care; and (3) potential targets for intervention. This was achieved through a review of English publications from 2000 onwards, sourced from six academic databases and complemented with a search for grey literature.

FINDINGS

A total of 4212 articles were reviewed to identify studies conducted in the UK, Canada, Holland (or The Netherlands), Australia, or New Zealand given the comparable role of PCPs. Several factors hinder PCP participation in cancer care, all of which are related to knowledge, attitudes, and beliefs. Patients and specialists are uncertain about the role that primary care could play and whether their primary care team has the necessary expertise. PCPs have varied opinions about the ideal content of follow-up programs. Study limitations include: the absence of well accepted definitions of key terms; the indexing systems used by databases to code publications, which may have obscured all relevant publications; the paucity of robust research; and possible researcher bias which was minimized through independent review by trained reviewers and the implementation of rigorous inter-rater reliability measures.

CONCLUSIONS

Knowledge, attitudes, and beliefs influence PCP engagement in cancer care. It is important to develop shared understandings of these terms because the knowledge, attitudes, and beliefs of PCPs, specialists, patients, and their families can influence the effectiveness of treatment plans.

Utility of stages of change construct in the planning of physical activity interventions among playgroup mothers

BACKGROUND

The objective of this research was to assess the physical activity levels among a unique cohort of Western Australian (WA) mothers with young children who attend a WA Playgroup. Associated factors were also investigated, including self-efficacy for physical activity, social support for exercise, relevant socio-demographic correlates, as well as the stages of change construct within the Transtheoretical Model (TTM).

RESULTS

421 women completed a questionnaire assessing physical activity behaviours. Of these, 368 participants completed the relevant physical activity evaluation items. 82.5% and 17.5% of the sample were classified as active and inactive, respectively. Associations between physical activity status and exercise stage of change were found. Additional associations were established for partner support and self-efficacy for physical activity.

CONCLUSION

The majority of the sample was classified as active. Despite the high percentage of active participants, this study confirms the usefulness of the stages of change measure in that it can be utilised by health promotion practitioners to report physical activity behaviour and develop appropriate intervention strategies among a time poor and hard to reach population. Specifically the results are relevant to mothers in over 16,000 WA families who are involved with Playgroup WA programs. Interventions aimed at improving physical activity levels in mothers with young children should also consider the need to improve self-efficacy and social support.

Physical activity for children in special school environment

1. We assessed children's physical activity (PA) in structured (physical education) and unstructured (recess, lunch, before and after school) periods in special schools and examined its association with modifiable area contextual characteristics. 2. Children with disabilities were not highly active, but were more active during recess and lunch periods than at other times including physical education classes. 3. Areas were often not accessible during unstructured settings. Children were more active in areas when supervision and organised activities were provided. 4. Providing an interactive game during free play did not significantly increase group's PA. 5. Children's PA accrual is influenced by contextual characteristics of the school environment. There is a need to make areas more accessible and to use social marketing and programming to attract more users. School and health professionals should modify contextual characteristics by providing more direct supervision and organised activities during free play.

Health promotion innovation in primary health care

Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.

Build it and they will come: outcomes from a successful cardiac rehabilitation program at an Aboriginal Medical Service

Objective. Cardiovascular disease (CVD) is the leading disease burden in Aboriginal Australians, but culturally appropriate cardiac rehabilitation programs are lacking. We evaluated the uptake and effects on lifestyle, and cardiovascular risk factors, of cardiac rehabilitation at an Aboriginal Medical Service (AMS). Methods. The program involved weekly exercise and education sessions (through ‘yarning’) for Aboriginal people with or at risk of CVD. Participants’ perceptions of the program and the impact on risk factors were evaluated following 8 weeks of attendance. Results. In twenty-eight participants (20 females) who completed 8 weeks of sessions, body mass index (34.0 ± 5.1 v. 33.3 ± 5.2 kg m–2; P < 0.05), waist girth (113 ± 14 v. 109 ± 13 cm; P < 0.01) and blood pressure (135/78 ± 20/12 v. 120/72 ± 16/5 mmHg; P < 0.05) decreased and 6- min walk distance increased (296 ± 115 v. 345 ± 135 m; P < 0.01). ‘Yarning’ helped identify and address a range of chronic health issues including medication compliance, risk factor review and chest pain management. Conclusions. AMS-based cardiac rehabilitation was well attended, and improved cardiovascular risk factors and health management. An AMS is an ideal location for managing cardiovascular health and provides a setting conducive to addressing a broad range of chronic conditions. What is known about the topic? Cardiovascular disease is the leading cause of morbidity and mortality in Aboriginal Australians, but less than 5% of eligible Aboriginal people attend hospital-based cardiac rehabilitation. What does this paper add? This is the first study to describe a culturally appropriate cardiac rehabilitation program conducted in a metropolitan Aboriginal Medical Service. It provides a detailed account of the program’s components and its effects on physical and psychosocial determinants of cardiovascular health in participants. What are the implications for practitioners? Health management programs similar to the one evaluated in this study could be developed to suit the specific needs of other Indigenous communities around Australia to address a range of chronic conditions.

Hepatitis C treatment - better outcomes through partner support

BACKGROUND

Globally, it is estimated that 170 million people are living with hepatitis C and between three and four million are newly infected annually. In Australia, around 1% of people are living with chronic hepatitis C, with two-thirds of these being men.

AIMS

This research aimed to determine the impact of hepatitis C treatment on partners of patients using in-depth exploratory techniques.

METHOD

Four infected men and their partners (n= 8 participants) and three service providers were recruited and interviewed separately to identify the needs of female partners supporting patients with Hepatitis C. Discussion was based on the experiences of female partners during the treatment phase of male hepatitis C patients.

RESULTS

All participants recognised a need for greater assistance for partners of hepatitis C treatment patients. It was also recognised that strong social support improved treatment outcomes and helped to maintain the survival of family relationships during the intensive treatment phase.

CONCLUSION

Although this research was limited by size, it provides valuable insights into ways to enhance hepatitis C management outcomes beyond traditional medical treatment regimes, for example through formal partner support.

Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University's Activity, Food and Attitudes Program--CAFAP) among overweight adolescents

Background

Current estimates place just under one quarter of adolescents in Australia as overweight or obese. Adolescence has been identified as a critical period for the development of obesity, yet despite this recognition, there is limited systematic research into or evaluation of interventions for overweight adolescents. Reviews have concluded that there is a substantive evidence gap for effective intervention, but physical activity, lifestyle change and family involvement have been identified as promising foci for treatment.

Methods

This paper reports on the development of a staggered-entry, waitlist controlled clinical trial to assess the impact of a multidisciplinary intervention aiming to change the poor health trajectory of overweight adolescents and help them avoid morbid obesity in adulthood—Curtin University’s Activity, Food and Attitudes Program (CAFAP). 96 adolescents, aged 11–16 years, and parents, will attend twice weekly during an 8 week intensive multidisciplinary program with maintenance follow-up focussed on improving activity, food and attitude habits. Follow-up assessments will be conducted immediately after completing the intensive program, and at 3, 6 and 12 months post intensive program. Main outcomes will be objectively-measured physical activity, sedentary behaviour and activity behaviours; food intake (measured by 3 day diary) and food behaviours; body composition, fitness and physical function; mental and social well-being (quality of life, mood and attitudes), and family functioning.

Discussion

This trial will provide important information to understand whether a community based multidisciplinary intervention can have short and medium term effects on activity and food habits, attitudes, and physical and mental health status of overweight adolescents.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12611001187932.

Undergraduate student drinking and related harms at an Australian university: web-based survey of a large random sample

Background

There is considerable interest in university student hazardous drinking among the media and policy makers. However there have been no population-based studies in Australia to date. We sought to estimate the prevalence and correlates of hazardous drinking and secondhand effects among undergraduates at a Western Australian university.

Method

We invited 13,000 randomly selected undergraduate students from a commuter university in Australia to participate in an online survey of university drinking. Responses were received from 7,237 students (56%), who served as participants in this study.

Results

Ninety percent had consumed alcohol in the last 12 months and 34% met criteria for hazardous drinking (AUDIT score ≥ 8 and greater than 6 standard drinks in one sitting in the previous month). Men and Australian/New Zealand residents had significantly increased odds (OR: 2.1; 95% CI: 1.9-2.3; OR: 5.2; 95% CI: 4.4-6.2) of being categorised as dependent (AUDIT score 20 or over) than women and non-residents. In the previous 4 weeks, 13% of students had been insulted or humiliated and 6% had been pushed, hit or otherwise assaulted by others who were drinking. One percent of respondents had experienced sexual assault in this time period.

Conclusions

Half of men and over a third of women were drinking at hazardous levels and a relatively large proportion of students were negatively affected by their own and other students' drinking. There is a need for intervention to reduce hazardous drinking early in university participation.

Trial registration

ACTRN12608000104358

How prepared is the retirement and residential aged care sector in Western Australia for older non-heterosexual people?

OBJECTIVE

To explore attitudes, knowledge and current practices of retirement and residential aged care providers in Western Australia towards accommodating older gay, lesbian, bisexual, transgender and intersex (GLBTI) individuals. GLBTI is used throughout as a general term to include people who are not exclusively heterosexual in identity, attraction and/or behaviour.

METHODS

Postal surveys were sent to 329 providers of accommodation to ask about their attitudes, knowledge and current practices towards older GLBTI people. Two focus groups were also held with managers of accommodation facilities and GLBTI community members.

RESULTS

Few respondents reported having experience with any older GLBTI residents in their retirement or residential aged care facility. There was poor inclusion of GLBTI issues in policy frameworks, and limited understanding regarding same-sex law reforms.

CONCLUSION

Older non-heterosexual people are often obscured within ageing population discourses, and conceal their identity for fear of discrimination. GLBTI-sensitive practices can help to facilitate the disclosure of sexual orientation and/or gender identity that may assist in meeting the unique needs of this group.

A critical review of nutrition resources for General Practitioners focusing on healthy diet, including seafood

BACKGROUND

General practitioners (GPs) are considered a trusted and reliable source of health-related information including nutritional advice. Preliminary investigation found that GPs wanted evidence-based nutrition resources that could be used within a 10 minute consultation.

AIM

The aim of the study was to identify and critically review current resources available to GPs that promote seafood consumption within a healthy diet, as a preventative or treatment measure for common lifestyle or medical conditions.

METHODS

English language resources currently available to GPs in 2008 were sourced through multiple avenues including: individual organisations; medical service networks; health information services and internet search engines. Assessment included critical review of: format; appropriateness for target groups; reference to seafood and supporting evidence; credibility; readability; and suitability for use by practitioners in a short consultation.

RESULTS

One hundred and twenty resources were identified. The majority (88.4%, n=106) of identified resource were available Electronically. Just over half (57.5%, n=69) of the resources were targeted at specific audiences. All of the resources made reference to the health benefits of regular consumption of fish (100%, n=120), 22.5% (n=27) made reference to seafood in general and 5% (n=6) made reference to fish oil. Only 15% (n=18) of the identified resources were suitable for use with the general Australian population at or below the recommended reading level of Year Eight. The majority (87.5%, n=105) of the identified resources were associated with credible sources of information about the health benefits of regular consumption of seafood.

CONCLUSIONS

This study found that the majority of resources available to GPs were not suitable for use with the general Australian population at the recommended reading level of Year 8 or lower. Whilst it is acknowledged that written health information alone cannot change health behaviours, it can provide accurate information to assist in making changes to behaviours with support from appropriate health care professionals.