16. A RANDOMIZED CONTROLLED TRIAL OF THE IMPACT OF EMAIL AND TEXT (SMS) MESSAGES ON THE SEXUAL HEALTH OF YOUNG PEOPLE

Objective: To trial a novel method of sexual health promotion - sending email and mobile phone text messages (SMS) about safe sex and STI to promote reductions in STI behaviours and increases in STI knowledge and testing. Methods: Young people (aged 16-29) were recruited at a music festival in Melbourne. They completed a questionnaire about sexual risk behaviour and were randomised to either the intervention arm of the study (to receive messages) or a control group. Text messages were sent every 3-4 weeks for a twelve month period and included catchy STI prevention slogans. Emails were sent monthly and contained detailed information about STI topics and links to related websites. Participants completed follow-up questionnaires online after 3, 6 and 12 months. Clustered weighted estimating equations were used to compare outcomes of the two groups. Results: 994 people completed at least one questionnaire (507 in the intervention group and 487 in the control group); at baseline 58% were female, the median age was 19 years and 82% had ever had sex. At 12 months, STI knowledge was higher among the intervention group for both males (OR 3.19, 95% CI 1.52, 6.69) and females (OR 2.36, 95% CI 1.27, 4.37). Females in the intervention group were also more likely to have discussed sexual health with a clinician (OR 2.92, 95% CI 1.66, 5.15) and to have had an STI test in the past 6 months (OR 2.51, 95% CI 1.11, 5.69). There were no significant differences in condom use between the groups. Respondents' opinions of the SMS and emails were positive. Conclusions: Receiving regular sexual health-related SMS and email messages can improve knowledge in young people and health seeking behaviour in young women. SMS and email are low cost, widely available and convenient, which - when combined with their popularity among youth - means that these media have considerable potential for sexual health promotion.

Isolated posterior cerebral artery dissection: report of three cases

Isolated dissection of the posterior cerebral artery (PCA) is a rare but important cause of stroke in younger patients, particularly women. We present 3 cases of dissection of the P2 segment of the PCA. In 2 patients, an association with minor axial head trauma was documented, suggesting shearing injury of the PCA as it crosses over the free edge of the tentorium. The clinical and imaging findings are discussed, and the therapeutic management is reviewed.

Use of a systematic review to assist the development of Campylobacter control strategies in broilers

AIMS

Produce an evidence-based ranking of the major contributing factors and sources of Campylobacter occurrence in broilers produced in England, Scotland and Wales - Great Britain (GB).

METHOD AND RESULTS

Relevant data were extracted from 159 research papers and findings were grouped into 14 sources of on-farm contamination and 37 contributing factors. A relevancy score was developed to take into account various measures from each study of applicability to GB broilers and strength of findings. Results indicate that major sources of Campylobacter include a depopulation event, another house on-farm, on-farm staff, and other animals on farm. The depopulation schedule (staggered slaughter) and multiple houses on-farm were identified as contributing factors associated with increasing the risk, and those decreasing the risk were use of a hygiene barrier, parent company and certain seasons of rearing.

CONCLUSIONS

Although the review was more resource intensive compared to narrative studies, the system allows an increased level of transparency and the ability to investigate patterns and trends.

SIGNIFICANCE AND IMPACT OF THE STUDY

This paper provides the first evidence-based ranking of the major sources and contributing factors for Campylobacter presence in broilers in GB using a systematic review.

Working with older people with communication difficulties: an evaluation of care worker training

Studies suggest that a high proportion of older people in residential and nursing care have communication difficulties and there is some awareness of the need for staff training to allow effective communication to be achieved. This paper describes part of the evaluation of a one-day training package aimed at enabling care staff to communicate with older people who have a variety of communication difficulties. Care staff from four partner agencies completed questionnaires pre- and post-training, addressing contact with people with communication disorders, previous training on communication, knowledge about communication, attitudes towards communication problems and strategies to help communication with people who have communication difficulties. Positive gains were found in attitudes and self-perceptions of knowledge and competence, as well as in appropriate citations of strategies to enhance communication. The findings are discussed with reference to the need for enhanced communication skills in care workers engendered by current developments in care policy.

Preventable adverse patient outcomes: a closed claims analysis of respiratory incidents

Closed claims analysis of adverse anesthesia outcomes was initiated through the AANA Foundation in 1995 to examine adverse outcomes of anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs). A research team of 8 CRNAs using an instrument incorporating more than 150 variables undertook document analyses of closed claim files. All files reviewed involved incidents in which the CRNA named in the policy was potentially involved in the adverse patient outcome. Thirty-eight percent (58/151) of CRNA-related claims involved a respiratory incident as the primary cause of the negative patient outcome. Patient outcomes involving respiratory incidents were more likely to result in death or permanent injury compared with nonrespiratory incidents (P < .01). Reviewers found that respiratory claims were more likely to have involved inappropriate anesthesia management (P < .01), more likely to have involved a lack of vigilance (P < .01), and more likely to have been judged by the reviewer as preventable (P < .01). A higher percentage of respiratory incidents occurred in emergency cases (75% vs 34%, P < .01) and in cases involving general anesthesia (44% vs 17%, P < .01). Adverse respiratory incidents are largely preventable and frequently result in serious patient morbidity and mortality.

Influence of structure on nickel-titanium endodontic instruments failure

The purpose of this work was to investigate the process history on fracture life of nickel-titanium endodontics files. The results are based on microstructural investigations of nickel-titanium engine-driven rotary instruments based on X-ray diffraction, scanning electron microscopy, and microhardness tests. Endodontic files are very work-hardened, and there is a high density of defects in the alloy that can disturb the phase transformation. The microhardness Vickers confirmed these observations (dislocations and precipitates). The X-rays show that experimental spectrum lines are extended, typical of a distorted lattice. The surface state of the endodontic files (scanning electron microscopy) is an important factor in failure and fracture initiation.

Seeing the person? Disability theories and speech and language therapy

The potential value of a framework enabling practitioners to conceptualise speech and language therapy from a range of perspectives engendered by different theories about disability is explored. Four disability research paradigms are used to categorise professional activities, whilst the 'individual' and 'social' models of disability are considered as alternative value systems. Challenges facing speech and language therapists in developing roles and services to embrace different perspectives are outlined.

Speech and language therapists as trainers: enabling care staff working with older people

A recently completed evaluation of a one day training package on communication has found evidence of a perceived need for training in both communication and communication impairment among care workers employed by health and social care agencies. This paper is a discussion of the factors that contribute to the delivery of successful workshops to front line care workers.

Longitudinal effects of integrated treatment on alcohol use for persons with serious mental illness and substance use disorders

A randomized experimental design was used to assign participants to an integrated mental health and substance use treatment program or to standard hospital treatment. A multilevel, nonlinear model was used to estimate hospital treatment effects on days of alcohol use for persons with serious mental illness and substance use disorders over 18 months. The integrated treatment program had a significant effect on the rate of alcohol use at 2 months postdischarge, reducing the rate of use by 54%. Motivation for sobriety at hospital discharge, posttreatment self-help attendance, and social support for sobriety were also found to reduce the rate of use during the follow-up period. Implications for mental health treatment and aftercare support are discussed.

Changing attitudes about persons with disabilities: effects of a simulation

The question of whether the use of a teaching strategy employing simulation influences attitudes toward disabled persons over time was addressed in this quasi-experimental intervention study. The experimental group participated in "Sensitivity Day" which incorporated a simulation activity. A total of 77 undergraduate baccalaureate nursing students completed the Attitudes Toward Disabled Persons scale four times: presimulation, immediate postsimulation, six week delayed postsimulation and six month delayed postsimulation. In general, the nursing students had relatively positive scores on the Attitudes Toward Disabled Persons scale in each testing period. The best indicator of postsimulation attitude scores was the presimulation attitude score. Personal and prior nursing experience had no statistical effects on attitude. Improvement that was significant at p = .07 level was noted in the experimental group at the six weeks delayed postsimulation when compared with the presimulation attitude scores. This study supplies data that is useful in constructing learning activities and contributes to the body of knowledge about simulation and attitudes toward persons with disabilities.

T wave alternans associated with HIV cardiomyopathy, erythromycin therapy, and electrolyte disturbances

We report a case of T wave alternans in a patient with HIV cardiomyopathy. T wave alternans is an unusual electrocardiographic finding in acquired long QT syndromes that can precede the development of torsades de pointes. Our patient had multiple risk factors for the development of the acquired long QT syndrome, including HIV cardiomyopathy, electrolyte disturbances, and erythromycin therapy. T wave alternans has not been described previously with HIV cardiomyopathy and only rarely with erythromycin therapy. Patients who have HIV cardiomyopathy and who receive intravenous erythromycin may benefit from monitoring for QT prolongation and electrolyte disturbances to avoid the development of torsades de pointes.

Obstetric outcome in women who present with a reduction in fetal movements in the third trimester of pregnancy

A complaint of decreased fetal movements is a common indication for the assessment of fetal well being. The aim of this study was to review the outcome of a group of women whose primary indication for referral was decreased fetal movements. Over a 20 month period, 435 patients were seen in the fetal assessment unit of an inner London teaching hospital, following a primary complaint of reduced fetal movements. Investigations included: the fetal abdominal circumference (AC), amniotic fluid volume (AFV), the umbilical artery pulsatility index (UAPI) derived from Doppler ultrasound waveforms and a computerised analysis of fetal heart rate (FHR) recordings or cardiotocograph (CTG). Outcome measures were: gestational age at delivery, Apgar score < 7 at 5 minutes, admission to the Special Care Baby Unit (SCBU), the need for delivery by an emergency cesarean section for fetal compromise (CSFC), and any perinatal deaths. A comparison of actual versus expected outcome for women with decreased fetal movement revealed the following relative risks, with the 95% confidence intervals (CI) in brackets; low 5 minute Apgar score 0.03 vs. 0.05 expected (CI = 0.01, 0.05), SCBU admission, 0.06 vs. 0.07 (0.04, 0.08), and preterm delivery, 0.08 vs. 0.11 (0.05, 0.10). Cesarean sections for fetal compromise, 0.07 vs. 0.053 (0.050-0.096). The addition of FHR monitoring to standard ultrasound assessment of well being did not appear to confer any added benefit. There were no fetal deaths. The outcome for pregnancies where the mother presents with decreased fetal movements in the third trimester is comparable with the outcome for the general population.

Generation, characterization and utilization of anti-human growth hormone 1-43, (hGH1-43), monoclonal antibodies in an ELISA

The major isoform of hGH is a polypeptide of 191 amino acids. Human GH1-43 is an amino terminal segment of hGH1-191 which comprises the first 43 amino acids. This peptide is a potent regulator of glucose homeostasis. To facilitate our understanding of the physiological regulation of hGH1-43 an assay to measure its levels in biological fluids and extracts is needed. This communication describes the development of anti-hGH1-43 monoclonal antibodies and their use in the development of an indirect competitive ELISA for the quantification of hGH1-43. Hybridomas were produced by the fusion of FOX-NY myeloma cells with spleen cells taken from a mouse immunized with hGH1-43. The hybridomas were screened for production of antibodies to hGH1-43 by antibody capture ELISA. Hybridomas which produced antibodies reactive to hGH1-43 were cloned by limiting dilution. Three monoclonal hybridomas, CCL-1, CCL-2, and CCL-3 were subsequently obtained. These hybridomas secreted antibodies that were highly reactive towards hGH1-43 but minimally reactive towards hGH1-191. The isotypes of the mAbs secreted by CCL-1, CCL-2 and CCL-3 were all IgG1 kappa as shown by isotype specific antibody capture analysis. An indirect competitive ELISA with a detection limit that ranged from 1 to 10 ng/ml was developed using mAbs from monoclonal hybridoma CCL-3. Dose-response curves for competing hGH1-191, hPRL, and hPL indicated minimal cross-reactivity of mAbs with these hormones and conversely, a high degree of specificity for hGH1-43. Dose-response curves for dilutions of human serum and pituitary extract were parallel to the standard. The availability of a sensitive assay for the measurement of hGH1-43 will help us answer questions regarding the biosynthesis, regulation of secretion, and role of hGH1-43 in the control of glucose homeostasis.

Communicate: organisational issues and their relevance for clinical evaluation

This paper reports the first findings of a two year project funded by the NHS Executive North Thames to provide an independent evaluation of Communicate, Action for Dysphasic Adults' training programme for carers of older people with communication impairments. The project comprises an organisational evaluation (January-July 1998) to review the use of Communicate by purchasers nationally and in the North Thames health region, and (from September 1998) a clinical evaluation in North Thames region, to investigate outcomes for communicatively impaired people themselves and for training participants. The paper outlines the research design and progress so far before presenting initial findings. It concludes by discussing the relevance of organisational issues and social science research insights to the forthcoming clinical evaluation.

Torsional properties of Ni-Ti and copper Ni-Ti wires: the effect of temperature on physical properties

The stress-strain behaviour of two Ni-Ti and two Copper Ni-Ti orthodontic wires was examined in induced torsion under controlled conditions of moment and temperature. The tests clearly demonstrate the diversity of behaviour of these wires. The loading and unloading curves and plateau regions were found to be closely related to temperature with stiffness varying dramatically over mouth temperature range under identical stress. Diversity of reaction to stress is linked to the crystalline structure of the alloys.

Comparative study of serological methods for the detection of antibodies to porcine reproductive and respiratory syndrome virus

A comparison was made of serological diagnostic methods used for the detection of antibodies against porcine reproductive and respiratory syndrome (PRRS) virus. In the "phase I" PRRS test panel comparison, a panel of sera collected from 135 pigs of various ages, from North American herds with and without PRRS histories, were sent to 4 different laboratories and tested by an indirect immunofluorescent assay (IFA), an immunoperoxidase monolayer assay (IPMA) and an indirect enzyme-linked immunosorbent assay (iELISA). In the "phase II" PRRS test panel comparison, a panel of 382 sera collected from pigs of various ages, PRRS histories, and from various locations in North America and France, were divided into 2 panels (A & B) and sent to 3 Canadian laboratories and tested by the IFA and iELISA. In the phase I comparison, agreement between the IFA of laboratory 4 and the iELISA and IPMA of laboratory 3 was excellent (kappa values of 95% and 98%, respectively). This contrasted with the poor agreement between these laboratories and the IFA results of laboratories 1 and 2 in the phase I trial. In the phase II comparison, the results demonstrated good agreement between various tests both within and between laboratories. The overall performance of the iELISA was superior in the combination of sensitivity (96.1%) and specificity (100%) relative to the reference classification of the serum samples and repeatability (kappa value 98%). The iELISA is technically superior to IFA and IPMA, time efficient, cost effective and suitable for testing of a large number of samples over a short period of time. Thus, the iELISA may be a better alternative to IFA or IPMA for routine detection of PRRS viral antibodies in swine sera.

The efficacy of trypsin for disinfection of in vitro fertilized bovine embryos exposed to bovine herpesvirus 1

Bovine cumulus-oocyte complexes (COC) or in vitro fertilized (IVF) embryos were exposed to bovine herpesvirus 1 (BHV-1) during in vitro maturation or co-culture with uterine tubal cells, respectively. Trypsin, at a concentration of 0.25%, was applied (for approximately 90 s) to disinfect either COC or cumulus-free oocytes (CFO) 18 h after insemination, or on day 7 to embryos resulting from infected oocytes. In total, virus was not detected in 71% of 93 samples containing 233 embryos exposed to BHV-1 and trypsin treatment. BHV-1 was detected in 14% and 54% of samples containing a single embryo and five embryos, respectively. In corresponding groups of embryos exposed to BHV-1, then washed but not treated with trypsin (70 samples), 85% and 96% of samples containing one embryo and pooled embryos, respectively, were positive for the virus. There was no effect of trypsin treatment on the development of IVF-embryos. It is concluded that IVF-generated embryos have a greater tendency to carry BHV-1 after experimental exposure to the virus than IVF uterine stage embryos, and that they are more difficult to disinfect by means of the standard trypsin treatment use.

Immediate outcomes of substance use treatment within a state psychiatric hospital

Outcomes of an integrated inpatient treatment program for persons with serious mental illness and substance use disorders are examined in relationship to five stages of treatment--stabilization, engagement, persuasion/awareness, active treatment, and relapse prevention. The study used a randomized design with participants assigned to an integrated mental health and substance abuse treatment program or standard psychiatric hospital treatment. At discharge, participants in the integrated treatment program indicated more active engagement in treatment and greater awareness of mental health issues, substance use issues, and the 12-step program than those who received standard hospital treatment. Participants in the integrated treatment program also saw their treatment as being more effective and had more motivation to stay healthy and sober. The integrated treatment program was not equally effective at each treatment stage with all participants. The implications of the program's success overall and at each treatment stage are discussed.

Early olfactory experience, novelty, and choice of sexual partner by male rats

After rearing by citral-scented or unscented dams, adult male rats were given simultaneous choices of citral-scented or unscented female partners in approach, contact, and sexual behavior tests. There was no evidence that mate choice had been affected by the early rearing experience. In Experiment 1, both citral and control males approached citral-scented females in a T-apparatus at slightly above chance levels and exhibited no differences in copulatory behavior during successive pairings. In Experiment 2, normally reared males directed their first mount more rapidly to a citral female, but otherwise mated equally with the scented and unscented females. In Experiment 3, citral-reared males approached citral and unscented females equally, whereas controls approached citral females less often. With 2 females in the same arena (Exp. 3), the first mount was more rapid when the odor of the partner matched that of the dam, but no other measure of sexual behavior was affected by the partner's odor. Despite the importance of early olfactory experience for the development of social behavior, a preference for estrous-related odors is evidently not learned before mating experience. Under some circumstances, a novel odor added to familiar conspecific odors may attract naive males to potential partners.