The role of the oncostatin M/OSM receptor β axis in activating dermal microvascular endothelial cells in systemic sclerosis

BACKGROUND

Scleroderma (SSc) is a rare autoimmune disease characterized by vascular impairment and progressive fibrosis of the skin and other organs. Oncostatin M, a member of the IL-6 family, is elevated in SSc serum and was recognized as a significant player in various stages of fibrosis. The goal of this study was to assess the contribution of the OSM/OSMRβ pathway to endothelial cell (EC) injury and activation in SSc.

METHODS

IHC and IF were used to assess the distribution of OSM and OSMRβ in SSc (n = 14) and healthy control (n = 7) skin biopsies. Cell culture experiments were performed in human dermal microvascular endothelial cells (HDMECs) and included mRNA and protein analysis, and cell migration and proliferation assays. Ex vivo skin organoid culture was used to evaluate the effect of OSM on perivascular fibrosis.

RESULTS

OSMRβ protein was elevated in dermal ECs and in fibroblasts of SSc patients. Treatments of HDMECs with OSM or IL-6+sIL-6R have demonstrated that both cytokines similarly stimulated proinflammatory genes and genes related to endothelial to mesenchymal transition (EndMT). OSM was more effective than IL-6+sIL-6R in inducing cell migration, while both treatments similarly induced cell proliferation. The effects of OSM were mediated via OSMRβ and STAT3, while the LIFR did not contribute to these responses. Both OSM and IL-6+sIL-6R induced profibrotic gene expression in HDMECs, as well as expansion of the perivascular PDGFRβ+ cells in the ex vivo human skin culture system. Additional studies in HDMECs showed that siRNA-mediated downregulation of FLI1 and its close homolog ERG resulted in increased expression of OSMRβ in HDMECs.

CONCLUSIONS

This work provides new insights into the role of the OSM/OSMRβ axis in activation/injury of dermal ECs and supports the involvement of this pathway in SSc vascular disease.

CPR Knowledge and Attitudes among High School Students Aged 15-16 in Hong Kong

Background

Sudden cardiac arrest is a serious public health problem in Hong Kong, with up to 85% of victims not surviving to hospital admission. International research findings show that teaching cardiopulmonary resuscitation (CPR) to lay bystanders can significantly improve out-of-hospital survival rates. A particular target group for CPR training and education is high school students. Since the commonest site of sudden cardiac deaths in Hong Kong occur at home, school-age adolescents are likely to be the only available bystanders in many emergent situations.

Design

Questionnaire survey.

Methods

This study investigated CPR knowledge and attitudes of 383 students aged 15-16 years across 18 schools in Hong Kong to understand barriers and facilitators for CPR delivery. A questionnaire pilot tested and validated by a panel of health professionals was distributed to students, using a convenience sampling methodology.

Results

Most students (87%) had not received CPR training, with common reasons for not attending being lack of time, lack of interest and not sure where to attend a course. Results of Mann Whitney U tests indicated that students who had received training scored significantly (p<0.05) higher on factual knowledge and also attitudes toward CPR training than those without training. There were no gender differences. Most students reported that they would attempt to perform CPR in a cardiac arrest situation, even if they had not received training, because they believed that CPR could increase the survival rate and it was morally the right thing to do.

Conclusions

Teaching CPR to Hong Kong school students is an effective way to develop the next generation of emergency first responders. (Hong Kong j.emerg.med. 2015;22:3-13)

Perceptions of legal and illegal drugs: comparisons of parents, adolescents, and best friends

The topic of drugs is a sensitive issue and an area where considerable conflict and disagreement may exist between parents and children. In this study, 50 family groups (consisting of father-mother-adolescent-adolescent's friend) responded to questions about a range of legal and illegal drugs used in Australia. A multidimensional scaling analysis revealed that parents, adolescents, and adolescents' best friends had similar perceptions about drugs, especially distinctions between legal and illegal substances, and drugs used more by younger people. LSD, cocaine and heroin were judged by all groups as causing personal and family problems, being strong and dangerous, not socially acceptable, bad for one's health and associated with crime. Marihuana, tobacco and alcohol were judged in opposite terms, as well as being perceived as popular, widespread and used by youth. Subjects' perceptions of drugs were very similar to representative state and national community samples, but were inaccurate when compared to official figures for drug prevalence and morbidity. In particular, respondents showed little appreciation of the problems associated with widely available legal drugs such as alcohol and tobacco.

Drinking habits of central Queensland adolescents: local research for local needs

This study examined the utility of monitoring adolescent drinking habits in order to assist the development of local drug education programmes. Drinking patterns are reported for a quota-sample of 1154 adolescents aged from 13 to 18 years in central Queensland. Results showed that the prevalence of drinking increased according to age, with 47% of 13-year-olds reporting that they have used alcohol (not just sips or tastes), through to 93% among the 18-year-old group. Older teenagers were more likely to report drinking in the past month and the past week, though their consumption patterns are very similar to young people in other studies. Locations for drinking varied with age, younger groups drinking more often in home settings while older groups enjoyed a greater range of public and private venues. Beverage preferences again showed some age and sex differences, but overall males expressed a preference for regular beer and spirits, while females reported a preference for spirits and wine coolers. The importance of conducting local research to address local needs is discussed.

Effect of television advertising of alcohol on alcohol consumption and intentions to drive

The alcohol consumption of 120 male and female college students was measured as they viewed a 90-min videotape of popular prime-time television programmes. Independent measures were the sex of the student, their drinker classification (light or moderate-heavy) and the number of alcohol advertisements (0, 6, 12) shown during the screening of the television programmes. Dependent measures were the number of drinks consumed, and the intentions of students to drive a motor vehicle after viewing the videotaped programmes. As predicted, males consumed more alcohol than females, and moderate-heavy drinkers consumed more than light drinkers. Male and female students who viewed six alcohol advertisements consumed more alcohol than students shown no alcohol advertisements or 12 alcohol advertisements. Analysis of intentions to drive after viewing the programmes revealed that the number of drinks consumed was not a significant covariate of driving intentions. Rather light drinkers of both sexes were less likely to intend to drive than moderate-heavy drinkers. Males exposed to alcohol advertisements were less likely to intend to drive than males who did not view alcohol advertisements. Different levels of exposure to alcohol advertisements did not influence the driving intentions of college females.

Adolescent views on risky and illegal alcohol use

A sample of 1154 adolescents from central Queensland indicated their agreement or disagreement with 28 reasons why young people drink alcohol in ways that are risky or illegal. As predicted, agreement varied across the three age groups sampled, with younger respondents being most likely to agree with drinking reasons. In contrast, very few sex differences emerged in the study. This suggests that young males and females share some common views about situations related to problematic alcohol consumption, and that age differences may be the more important factor in the development of alcohol education messages.

A diary approach to analysing young adults' drinking events and motivations

Completing a diary over two weeks, 201 young adults recorded each of their drinking events, and information about the context and their motivations for alcohol use. Males reported almost twice as many drinking events and three times the number of drinks over the two-week period. At the same time, males and females mostly drank from Wednesdays to Sundays, with the majority of beer, wine and spirit consumption being between 4 p.m. and midnight. Most drinking occurred in mixed-sex peer groups, and the next greatest in family gatherings. Males mostly drank beer, while females chose either wine or spirits. Most drinking was in bars or at home. Males tended to drink for a wider range of reasons. The advantages of using prospective diaries in studies of young adults' alcohol use are discussed.

Extending upon student drinking patterns in an Australian population

One hundred and twenty-two students from the University of Queensland were surveyed regarding their attitudes and behaviour toward alcohol. As an extension of earlier investigations at the same university the study provides some monitoring of drinking levels over 8 years. Results indicate that the quantity and frequency of male consumption continues to be greater than that of females. Sex differences were also evident in beverage preferences. An increase in the proportion of males drinking more than 40 grams of alcohol per day was noted. The implications of this finding are discussed within the broader context of comparisons across studies and with reference to National Health and Medical Research Council recommendations for alcohol consumption.

Evaluation of a strategy for changing group stereotypes of the heroin user

This study examined characteristics attributed to a person using an illegal narcotic drug (heroin) and sought to change established stereotypes by participation in a group education experience. Prior to the main study, 100 Advanced Psychology students generated lists of adjectives they would use to describe a heroin user. The most frequently mentioned characteristics were placed in structured lists as pre- and post-test measures. Both semantic differential and open-choice formats were used. The Prevention Role Play, a recently developed strategy in drug education, was used to challenge the group's stereotypes. Significant shifts in attributions were revealed between the pre- and post-test measures. After the Role Play students reduced their negative stereotype on a number of dimensions though they still described the heroin user as confused, insecure, troubled and lonely. The discussion considers possible strategies for facilitating positive attitude change.

Overseas visitors admitted to Queensland hospitals for water-related injuries

OBJECTIVE

To determine the number of overseas visitors admitted to Queensland hospitals for water-related injuries over three years, the causes of their injuries, the resulting conditions treated, and the type of hospitals to which they were admitted.

DESIGN

Retrospective analysis of admissions of overseas visitors to Queensland hospitals over the three financial years 1995/96, 1996/97 and 1997/98.

PATIENTS

296 overseas visitors admitted for water-related injuries, identified from hospital records by their usual place of residence.

MAIN OUTCOME MEASURES

Number of admissions, causes of injuries, conditions treated, and bed days occupied by these patients at different types of hospitals (metropolitan, regional and rural public hospitals, and private hospitals).

RESULTS

The 296 overseas visitors accounted for a total of 596 separate admissions, many of these the result of patients with decompression illness being admitted several times to a regional hospital hyperbaric chamber for treatment as day patients. The largest number of injuries involved the use of diving equipment. The main conditions treated were decompression illness (54.7%), fractures and dislocations (15.5%), and drowning and non-fatal submersion (14.9%). Overall, overseas visitors admitted to hospital following a water-related incident occupied 1215 bed days; 90% of these admissions were to regional hospitals.

CONCLUSIONS

The main reason for admission of overseas visitors is for decompression illness, suggesting that the prevention of injuries among scuba divers requires further coordinated efforts by health and tourism authorities.

Randomised controlled trial of early surgery versus watchful waiting for glue ear: the effect on behavioural problems in pre-school children

This trial was designed to compare early surgery with watchful waiting for persistent bilateral otitis media with effusion (OME) in terms of hearing loss and behavioural problems in pre-school children. A randomised controlled trial compared the effects of early treatment with ventilation tubes versus watchful waiting for 9 months. Results were analysed by intention-to-treat. One hundred and eighty-two pre-school children (date of birth between 1 April 1991 and 31 December 1992), mean age of 2.9 years (SD 0.85) with at least a 3-month history of bilateral OME and hearing loss of greater than 25 dB were treated in Bristol Children's Hospital between November 1993 and January 1996. Bilateral ventilation tubes were inserted within 6 weeks of randomisation or within 6 weeks of reassessment after 9 months of watchful waiting, with a final assessment at 18 months. The main outcome measures were behavioural problems, measured by the Richman Behaviour Checklist, and hearing loss at 4000 Hz in the better hearing ear. Early surgical intervention significantly reduced behavioural problems by 17% (95% CI, 2% - 33%). This difference was largely mediated by concurrent hearing loss. After 18 months, there was no longer a significant difference (95% Cl, -19% to +10%). However, the majority (85%) of the Watchful Waiting group had required surgery and 22% of all children still had behavioural problems.

International tourists, motor vehicles and road safety: a review of the literature leading up to the Sydney 2000 Olympics

The number of international visitors to Australia is forecast to rise to 4.6 million in the year 2000, the main attraction being the Olympic Games in Sydney. While the Olympic Games are expected to directly attract 132,000 international visitors as athletes, officials, judges, journalists and spectators, a further 1.49 million visitors will be attracted to Australia because of the global spotlight on the country in the years leading up to and during the staging of the event. Pre- and post-Games travel will also involve large numbers of tourists moving about in other Australian states and territories. For example, 50% of the extra tourists are expected to visit Queensland, 25% Victoria, 13% Western Australia and 9% the Northern Territory. In order to provide the best possible experience for all of these visitors, it is essential that potential causes of travel-related illness and/or injury are anticipated, and that procedures are established in each state to minimize harm and to deliver appropriate health care if it is required. Ideally, procedures and resources should be coordinated to achieve maximum effectiveness.

Early surgery compared with watchful waiting for glue ear and effect on language development in preschool children: a randomised trial

BACKGROUND

Otitis media with effusion (OME) is the most common cause of hearing loss in children and is generally treated by elective surgery. We compared in children with persistent OME the effect on speech and language development of immediate surgery (ventilation-tube insertion) and watchful waiting before surgery.

METHODS

We did a randomised controlled trial with masked outcome assessment in Bristol Children's Hospital, Bristol, UK. We included 186 children born between April 1, 1991, and Dec 31, 1992, who had confirmed bilateral OME and bilateral hearing impairment of 25-70 dB of at least 3 months' duration. Children were randomly assigned surgery within 6 weeks (n=92), or 9 months of watchful waiting (n=90), after which bilateral tube insertion was done if required. We assessed hearing loss, expressive language, and verbal comprehension at 9 months and 18 months.

FINDINGS

At 9 months, standardised scores for expressive language and verbal comprehension differed between groups with marginal significance after adjustment for baseline differences (p=0.04 and p=0.028, respectively). At 9 months, verbal comprehension and expressive language skills in the watchful-waiting group were 3.24 months behind those in the early-surgery group. The watchful-waiting group was delayed on these two measures compared with their age-expected levels. 18 months after randomisation, 85% of children in the watchful-waiting group had received surgery and groups did not differ significantly.

INTERPRETATION

There is some benefit from ventilation-tube insertion for expressive language and verbal comprehension but the timing of surgery is not critical.

Revising current two-process accounts of spacing effects in memory

Memory for repeated items improves when presentations are spaced during study. In Experiment 1A, words were repeated either immediately or after 6 intervening items. Intentional learning occurred under either focused or divided attention. Retention was tested by either free recall or yes-no recognition. Divided attention did not affect the influence of spacing in free recall, whereas it removed the spacing effect in recognition. In Experiment 1B, recognition memory was tested after incidental semantic study of words performed under either focused or divided attention. An equivalent spacing effect occurred in both attentional conditions. In Experiments 2 and 3, recognition memory for unfamiliar faces was assessed. A reliable spacing effect was found under both intentional learning and incidental structural study. These data are, collectively, incompatible with current theories of spacing effects. A theoretical proposal to account for these new findings is outlined.

Revising current two-process accounts of spacing effects in memory

Memory for repeated items improves when presentations are spaced during study. In Experiment 1A, words were repeated either immediately or after 6 intervening items. Intentional learning occurred under either focused or divided attention. Retention was tested by either free recall or yes-no recognition. Divided attention did not affect the influence of spacing in free recall, whereas it removed the spacing effect in recognition. In Experiment 1B, recognition memory was tested after incidental semantic study of words performed under either focused or divided attention. An equivalent spacing effect occurred in both attentional conditions. In Experiments 2 and 3, recognition memory for unfamiliar faces was assessed. A reliable spacing effect was found under both intentional learning and incidental structural study. These data are, collectively, incompatible with current theories of spacing effects. A theoretical proposal to account for these new findings is outlined.

Managing patient records and documenting service delivery: the results of a 'best practice' remote area nursing program

This paper describes a 'best practice' demonstration program for monitoring nursing services in remote locations. A four-phase project involving paper- and computer-based patient information systems was implemented at nursing clinics on islands off the coast of Queensland. Patient demographics, diagnoses and details of health service provision were recorded. Results showed a marked improvement in the detail of patient records over the program period. Monitoring of services also provided useful planning and policy information for company management, while a systematic approach to maintaining patient records addressed several medico-legal issues.

Travel and Health Research in Australia

Travel and tourism is a major industry in Australia, employing 6.9% of the nation's workforce (535,600 persons) and generating AUS$46.9 billion in 1993-94.1 While economic and marketing analyses have traditionally dominated the field of tourism research in Australia, health and safety issues that impact on the business of tourism are now emerging.2 Travel medicine is still a small specialty area, though it has established a legitimate role within the tourism industry by providing services in prevention and treatment. To date, little attention has been given to empirical research, even though field studies are a critical component in the provision of accurate medical advice for patients. This paper reviews the Australian research that is available and identifies areas where further work should be conducted.

Golf-related injuries seen at hospital emergency departments

Golf-related injuries are reported for 300 patients attending emergency departments of south-east Queensland hospitals over a six and a half year period. The main mechanisms of golf-related injury were being hit by a club (37%), hit by a ball (28%), sprains/strains (9.67%) and slips/falls (7%). For adult players, the main source of injury was being hit by a ball, while for children and adolescents being struck by a golf club accounted for 77 percent of hospital presentations. In the total study group, 46 people (15%) were admitted to hospital following their presentation at the emergency departments. Injury prevention and player education strategies are suggested as a means of reducing injuries in this popular sport.

Tourists as inpatients in Queensland regional hospitals

This study analysed medical record data from seven regional hospitals in Queensland to determine the types of medical conditions and injuries that resulted in overseas and interstate tourists being admitted to hospital. From a total of 135,128 admissions to the participating hospitals, 695 (0.51 per cent) were identified as overseas tourists and 3479 (2.57 per cent) were from interstate. The main reasons for admission of overseas tourists, based on principal diagnoses, were injuries and poisonings (37.6 per cent), circulatory disorders (11.7 per cent), digestive conditions (9.8 per cent), and genito-urinary disorders (8.8 per cent). For interstate tourists, the main reasons for admission were genito-urinary disorders (19.8 per cent), injuries and poisonings (15.4 percent), neoplasms (11.4 per cent) and circulatory disorders (10.6 per cent). These findings are discussed in relation to current literature in the field of travel medicine, emphasising the burden of care placed on the admitting hospital's resources, and the growing number of visitors to Queensland needing health care.

Comparing ICD-9-CM and ICD-10 classification systems in a primary health care setting: some initial observations

The ICD-10 is due to be introduced into Australia during the late 1990s, superseding the current and widely used ICD-9-CM. Improvements in areas such as number of codes, an expanded external cause framework, and more context to injuries are expected to make the ICD-10 a more streamlined system for practitioners. The present study examined both classification formats using data from 1183 presentations to primary health clinics at island tourist resorts. Some initial observations are made about differences in the two systems, highlighting the greater coding detail provided by the ICD-10, particularly in the area of injuries. It is recommended that further empirical testing be undertaken using the ICD-10 in a variety of settings so as to identify benefits in the coding of both medical conditions and injuries.

Use of Queensland Hospital services by interstate and overseas visitors

In response to concerns about the number of interstate and overseas visitors using Queensland hospital services, the present study examined a sample of 1,295 hospital records to determine the proportion of patients who were incorrectly identified as Queensland residents. Across six hospitals the overall detection rate was 4.6%. Rates varied between hospitals, with the highest detection recorded for Goondiwindi near the Queensland/New South Wales border; and the lowest for Prince Charles in Brisbane. There were also important variations across hospitals based on specific holiday periods. In particular, Goondiwindi and the Gold Coast had substantially higher detection rates for the Christmas holiday period (December-January) than for the mid-year period (June-August). These findings are discussed in terms of their implications for hospital services, especially lost revenue and increased patient load. Health information managers are identified as a key group for addressing some of the current problems in this area.

Tourist health services at tropical island resorts

An unfamiliar holiday environment may give rise to a range of common and unique medical conditions and injuries. Based on a six-month retrospective analysis of clinic records, the present study reports a detailed profile of health services provided for guests at three tropical island tourist resorts. A total of 1183 clinic visits were analysed; 735 (62 per cent) concerned medical conditions, while 448 (38 per cent) were related to injuries. The most common medical conditions treated were respiratory, digestive, skin problems, eye disorders, and genito-urinary complaints. Injuries included lacerations, bites and stings, sprains and fractures. Health services consisted mainly of medication, specialist nursing care and first aid. Study findings highlight the advantages of using an internationally accepted classification system for primary health research, and the critical role of the nurse in tourist health services.

A profile of therapeutic opioid dependent persons in Queensland

This paper describes the philosophy and practice of the Drugs of Dependence Unit, Queensland Health, with regard to the collection and evaluation of dangerous drug prescription data. Using patient information extracted from the Monitoring of Dangerous Drugs Computer System and patient files at the unit, the paper presents a profile of 335 therapeutic opioid dependent persons who constituted the entire therapeutic caseload of the unit as at June 1992. The data include medical history, drug details, initial and final diagnosis, an escalation factor, and prognosis. Profile findings detail the prescribing patterns of medical practitioners and highlight the importance of continuous monitoring and review in the care and management of therapeutic opioid dependent persons.

An evaluation of the Taxi Subsidy Scheme for the Disabled

This paper reports on an evaluation of the Taxi Subsidy Scheme for the Disabled (TSSD). The evaluation focused on members of the TSSD in terms of their eligibility for Home and Community Care (HACC) Program Services. Using a probability sample in the Brisbane metropolitan area, the project found evidence that at least 79 per cent of TSSD members (under the relevant category) were entitled to such membership, as they also fulfil the requirements prescribed under the Home and Community Care Act 1985. However, the evaluation also found evidence that current utilisation of HACC Program Services does not truly reflect the need for these services within the community.

Alcoholism and family interaction

In 16 families, half of which had an alcoholic parent, both parents and an adolescent were videotaped interacting with each other. Mothers, fathers and the adolescent in each family viewed the videotaped interaction and completed ratings of themselves and the other two family members on levels of anxiety, involvement, dominance and friendliness. In families with an alcoholic parent, adolescents and their mothers rated family members as less anxious than did adolescents and mothers in families without a drinking problem. Also mothers in the alcoholic families rated family members as being more involved, and their ratings were higher than mothers in other families. Alcoholic families rated parent-adolescent interactions as more dominant and friendlier. At least in these videotaped interactions where alcohol was not being consumed, mothers in alcoholic families adopted a more positive view of family members than mothers in other families. In addition, possibly due to the efforts of fathers not to drink and memories of interactions when he was drunk, alcoholic families perceived their family interactions as more dominant and friendlier than families without an alcohol-related problem.

Parent, peer and personal determinants of adolescent drinking

This study examined direct and indirect influences of parents and peers on adolescent drinking. One hundred and six adolescents, their parents and a same-sex best friend of the adolescent each completed measures that tapped actual and perceived drinking behaviour, and normative standards for alcohol use. Of methodological interest was that adolescents of both sexes provided accurate reports of their parents' and peer's drinking, as well as drinking norms. Path analyses revealed different effects for male and female adolescents. Strongest predictors of alcohol use for males were their perceptions of their father's and mother's drinking, and their father's actual drinking. Best friend's drinking was positively related to the adolescent males' perceptions of themselves as a drinker. The single predictor of their internalized norms was the perception adolescent males had of their friend's drinking. Significantly, the adolescent male's own norms predicted how much and what they drank. For adolescent females, how much they believed their best friend drank, and their friend's normative standards, were the strongest predictors of alcohol use. Father's drinking also influenced the drinking practices of daughters, but mothers had no impact on their daughters' alcohol use. In contrast to young males, females' personal preferences or liking of alcohol successfully predicted most of their drinking behaviour.

Cross-cultural perspectives on teenage attitudes to alcohol

Six hundred and seventy-seven indigenous Papua New Guinean, 315 Australian, and 166 American high school teenagers completed a series of measures on attitudes to alcohol. Papua New Guinean students differed most from other students in considering that money was wasted on alcohol and that preventive steps should be adopted to ban sales of take-away alcohol. In addition, Papua New Guinean males and females were more likely than other teenagers to feel that women should not drink alcoholic beverages. Within countries, males and females had fairly similar attitudes about alcohol and alcohol-related issues, and where differences occurred, males generally were less likely to highlight the costs of alcohol abuse.