Royal Australian College of Ophthalmologists and Royal Australian College of General Practitioners National GP Eye Skills Workshops: colleges and divisions reskilling general practice

PURPOSE

Little formal eye skills training has historically been available to Australian general practitioners at undergraduate or postgraduate levels. The development of the National GP Eye Skills Workshop was a joint initiatve of the Royal Australian Colleges of General Practice and Ophthalmology, to enhance the skills of Australian general practitioners in a range of important ocular examination and procedural areas.

METHODS

Workshops were run in eight Queensland Divisions of General Practice in 1998. Between two and 10 local ophthalmologists in each divisional area were involved ether in the workshop programme or in the recruitment of patients for the patient assessment module. Workshops were run on weekends and included modules on vision testing and disease screening in children and adults, ophthalmoscopy, assessment for glaucoma and diabetic retinopathy, incision of chalazions, removal of corneal foreign bodies, ocular first aid, implementing eye assessment in busy general practice, and a patient assessment clinic. A questionnaire was administered which was comprised of sections relating to the format of the workshop, new skills and concepts learnt, learning exceptions, and perception of future ability to treat/scan/assess for eye conditions in general practice. The questionnaire was completed by 91% of participants.

RESULTS

Participants strongly supported the impact of the workshop on their ability to detect and treat eye problems in their practices, and refer where appropriate to an ophthalmologist. They also rated highly all individual aspects of the programme in terms of impact on their delivery of general practitioner eye care.

CONCLUSIONS

The results illustrate the comprehensive success of the workshop programme in format, content, relevance and delivery.

Cellular radiosensitivity and complication risk after curative radiotherapy

PURPOSE

To test for an association between in vitro fibroblast radiosensitivity and complication risk in a case-control study of breast cancer patients treated under standard conditions in a clinical trial of radiotherapy dose fractionation.

PATIENTS AND METHODS

A cohort of patients participating in a randomised clinical trial of radiotherapy dose fractionation was selected on the basis of treatment-induced changes in the breast several years later. Thirty-nine cases with marked normal tissue changes were matched on several variables with 65 controls with no changes attributable to radiotherapy. Dermal fibroblast strains were established from duplicate skin biopsies, and clonogenic cell survival assays performed in triplicate after both high ( approximately 1.6 Gy/min) and low ( approximately 1 cGy/min) dose-rate irradiation. Laboratory studies were blind to patient identity, treatment outcome and radiotherapy schedule.

RESULTS

Analysis of 1128 clonogenic survival curves confirmed significant inter-patient variation in fibroblast radiosensitivity as measured by clonogenic survival. However, no association between fibroblast radiosensitivity and the development of late radiotherapy normal tissue effects was detected.

CONCLUSIONS

Inter-individual variation in cellular radiosensitivity may not be the main determinant of complication risk in patients undergoing radiotherapy for breast cancer. Other biological and technical factors may be more important in explaining the marked inter-patient differences in normal tissue damage evident several years after curative radiotherapy.

Neurotologic follow-up after radiation of posterior fossa tumors

OBJECTIVE

Stereotactic radiation treatment, also known as gamma knife surgery or radiosurgery, has come into acceptance as a treatment alternative to surgical removal for posterior fossa tumors. The purpose of this article is to describe the role of the neurotologist in the optimal management of neurotologic complications after stereotactic radiation, as illustrated by five patients.

STUDY DESIGN

Retrospective chart review.

PATIENTS

Five patients who underwent stereotactic radiation of posterior fossa tumors.

MAIN OUTCOME MEASURES

Presence or absence of neurotologic complications (tumor growth, hearing loss, imbalance/ataxia, vertigo, and facial paralysis) or neurosurgical complaints (facial numbness, motor weakness, headache, hydrocephalus, and subarachnoid cysts).

RESULTS

Postradiation neurotologic complaints included vertigo, imbalance/ataxia, and progressive hearing loss in four of the five patients. Continued tumor growth occurred in two patients; two patients had no growth; in one patient the tumor became smaller. The complications of facial nerve paralysis, facial numbness, motor weakness, headache, hydrocephalus, cerebellar edema, and posterior fossa arachnoid cyst formation occurred less frequently.

CONCLUSIONS

Stereotactic radiation of posterior fossa tumors can produce significant neurotologic problems. It is imperative that neurotologists remain involved in the follow-up care of patients with posterior fossa tumors to offer optimal treatment alternatives for the neurotologic disorders.

Opioid peptide receptor studies. 10. Nor-BNI differentially inhibits kappa receptor agonist-induced G-protein activation in the guinea pig caudate: further evidence of kappa receptor heterogeneity

There is strong evidence supporting the existence of multiple kappa receptors. Previous studies proposed that U69,593 and (+)-tifluadom act on different kappa receptor subtypes, kappa(1) (kappa(1)) and kappa(2) (kappa(2)), respectively. In this study, we investigated the effects of the kappa selective antagonist nor-binaltorphimine (Nor-BNI) on U69,593- and (+)-tifluadom-induced receptor-mediated stimulation of [(35)S]-GTP-gamma-S binding in the guinea pig caudate. The IC(50) value of Nor-BNI in the presence of a stimulating concentration of U69,593 (1 microM) was 0.19+/-0.02; while the IC(50) for Nor-BNI in the presence of (+)-tifluadom (1 microM) was 13.9+/- 1.62 nM. The mu-opioid receptor antagonist CTAP (10,000 nM) significantly reduced (+)-tifluadom-stimulated [(35)S]-GTP-gamma-S binding in rat brain sections and guinea pig brain membranes, indicating that (+)-tifluadom has mu agonist activity. Under conditions in which the mu agonist activity of (+)-tifluadom was blocked by 1000 nM CTAP the Ki value for Nor-BNI for inhibition of U69,593-stimulated [(35)S]-GTP-gamma-S binding was 0.036+/-.004 nM, whereas, its Ki value for the (+)-tifluadom-stimulated [(35)S]-GTP-gamma-S binding was 0.27+/-.015 nM. These results suggest that (+)-tifluadom and U69,593 activate pharmacologically different receptors. This study provides functional evidence in support of kappa receptor heterogeneity.

Underlying structure of the National Institutes of Health Stroke Scale: results of a factor analysis. NINDS tPA Stroke Trial Investigators

BACKGROUND AND PURPOSE

No stroke scale has been validated as an outcome measure using data from a clinical trial demonstrating a positive therapeutic effect. Therefore, we proposed to use data from the National Institute of Neurological Disorders and Stroke (NINDS) tPA Stroke Trial to determine whether the National Institutes of Health Stroke Scale (NIHSS) was valid in patients treated with tissue plasminogen activator (tPA) and to explore the underlying clinimetric structure of the NIHSS.

METHODS

We performed an exploratory factor analysis of NIHSS data from Part 1 (n=291) of the NINDS tPA Stroke Trial to derive a hypothesized underlying factor structure. We then performed a confirmatory factor analysis of this structure using NIHSS data from Part 2 of the same trial (n=333). We then tested whether this final factor structure could be found in tPA- and placebo-treated patients serially over time after stroke treatment. Using 3-month outcome data, we tested for an association between the NIHSS and other measures of stroke outcome.

RESULTS

The exploratory analysis suggested that there were 2 factors underlying the NIHSS, representing left and right brain function, confirming the content validity of the scale. An alternative structure composed of 4 factors could be derived, with a better goodness of fit: the first 2 factors could represent left brain cortical and motor function, respectively, and the second 2 factors could represent right brain cortical and motor function, respectively. The same factor structures were then found in tPA and placebo patient groups studied serially over time, confirming the exploratory analysis. All 3-month clinical outcomes were associated with each other at subsequent time points, confirming predictive validity.

CONCLUSIONS

This is the first study of the validity of a stroke scale in patients treated with effective stroke therapy. The NIHSS appeared to be valid in patients with acute stroke and for finding treatment-related differences. The scale was valid when used serially over time after stroke, up to 3 months, and showed good agreement with other measures of outcome.

A GP prescribing educational intervention involving a medication panel

AIM

To trial an educational intervention for general practitioners promoting Quality Use of Medicines.

METHOD

Twenty-three general practitioners (GPs) from the Brisbane Inner South Division participated in 12 prescribing upskilling sessions over 13 months. The educational intervention utilised an interactive small group, case based approach with panel input from a GP, pharmacist, clinical specialist, consumer with a related diagnosis, and clinical pharmacologist, focusing on areas of nominated interest. Participants also had access to a therapeutic drug management phone service.

RESULTS

Twenty-one (91%) participants completed nine or more sessions and a total of 319 of a possible 324 (98.5%) format evaluations were completed on educational sessions three to eleven. Pre and post session multiple choice questions (MCQs) were used to evaluate change in prescribing knowledge for eight of the sessions. All sessions showed a statistically significant improvement post intervention in both individual participant and overall group knowledge scores (p < 0.001). Participant feedback highlighted that: 100% agreed or strongly agreed that the educational content, panel discussion and summaries were relevant to their practice; 80% agreed or strongly agreed that the sessions were helpful in the management of their patients; 85% agreed or strongly agreed that they had gained new knowledge/skills they would apply in their practice. The therapeutic drug management phone service was utilised at least once by 72% of participants.

DISCUSSION

The use of an interactive, case based prescribing intervention with medication team input, positively influences GP prescribing knowledge and management intent.

Pulmonary evaluation and prevalence of non-invasive ventilation in patients with amyotrophic lateral sclerosis: a multicenter survey and proposal of a pulmonary protocol

In order to evaluate the current standard of care for the management of respiratory failure in patients with amyotrophic lateral sclerosis (ALS), a questionaire was mailed to the Medical Directors of 48 multidisciplinary ALS centers in the United States. Twenty centers reported information on 2357 patients, mean of 124 patients per center. Pulmonary function tests were performed at each visit in 17/20 institutions. Arterial blood gases, maximal expiratory pressures and maximal inspiratory pressures were followed in three centers and serum chloride was monitored in only four centers. The use of non-invasive ventilation (NIV) was extremely variable (range 0-50%) and included 360 patients (15%). The majority of centers used symptoms/signs of hypoventilation and worsening forced vital capacity (FVC) to initiate NIV with no established protocol. A FVC between 20 and 40% was used by most centers to initiate NIV. Due to great variability in the approach to monitoring pulmonary function among ALS centers and the modest effects of current medications to slow disease progression, we propose the use of a structured protocol which can prospectively study the role of NIV in prolonging survival and improving quality of life.

Changes in serum chondroitin sulphate epitopes 3-B-3 and 7-D-4 in early rheumatoid arthritis

OBJECTIVES

The aims of the present rheumatoid arthritis (RA) study were (1) to examine the levels of serum 3-B-3 and 7-D-4 to find out whether they are different from controls, (2) to find out whether the concentrations of these epitopes change with disease duration in early RA and (3) whether the serum concentrations of 3-B-3 and 7-D-4 in early RA are prognostic for subsequent disease progression.

METHODS

The concentrations of 3-B-3 and 7-D-4 in sera were quantitated by immunoassays.

RESULTS

The levels of 3-B-3 and 7-D-4 were significantly lower in RA than in controls (3- to 30-fold, P < 0.001). Changes in 3-B-3 and 7-D-4 were apparent with disease duration. At first presentation, the 3-B-3 concentration was lowest and increased at 12 months (3-fold, P < 0.001). This increase was transient since by 24 and 36 months the concentrations were not different to those at first presentation. The level of 7-D-4 was also lowest when the patients first presented at clinic and increased with time at 6 months (2-fold, P < 0.001). The increase was more prolonged for 7-D-4, remaining elevated at 12, 24 and 36 months. The lack of correlations of serum 3-B-3 and 7-D-4 with clinical measurements showed that these markers were not prognostic for disease severity.

CONCLUSIONS

The levels of 3-B-3 and 7-D-4 differed between RA and control sera, and changed with disease duration. These markers were not prognostic in predicting disease outcome.

Short day length alone does not inhibit spermatogenesis in the seasonally breeding four-striped field mouse (Rhabdomys pumilio)

This study was an examination of the effect of photoperiod on spermatogenesis and the accessory glands of the four-striped field mouse (Rhabdomys pumilio), a seasonally breeding rodent that occurs through Southern Africa. Adult scrotal males were exposed to either short day length (10L:14D), long day length (14L:10D), or natural photoperiod in constant-environment rooms (25 degrees C, 41% humidity; food and water ad libitum) for 8 wk in late summer, when males in the wild were spermatogenically active, and in mid-winter, when they were inactive. In neither experiment did prolonged exposure to short day length or naturally decreasing day length inhibit spermatogenic activity, and we conclude that the normal cessation of spermatogenesis that occurs in most male four-striped field mice in winter is not stimulated by day length alone.

Alcohol-specific socialization, parenting behaviors and alcohol use by children

OBJECTIVE

This panel study examined the relations between alcohol-specific socialization by parents (monitoring of alcohol use by children, allowing alcohol use by children at home, communicating against alcohol use and setting rules against alcohol use), general dimensions of parenting behavior (responsiveness and demandingness) and alcohol use by children.

METHOD

A sample of 488 fifth-grade children reported their perceptions of alcohol-specific socialization by parents, parental responsiveness and parental demandingness. These variables were used to predict alcohol use when children in the panel were in seventh grade.

RESULTS

Nineteen percent of seventh-grade children reported alcohol use in the past 30 days. Logistic regression analyses indicated that, after accounting for children's age, sex, single parent status, prior use of alcohol and exposure to parental modeling of alcohol use, the odds of alcohol use were significantly greater among children who perceived no parental monitoring of alcohol use, who had been allowed by parents to have a drink with alcohol at home and who perceived relatively low levels of parental demandingness. Rules against alcohol use, parental communication against alcohol use and parental responsiveness were unrelated to the study outcome.

CONCLUSIONS

Parental monitoring of alcohol use by children, family norms regarding alcohol use by children at home and parental ability to set and enforce behavioral rules merit consideration as factors that should be modified by prevention programs. There is a need, however, for additional research that further examines the relations between exposure to such parenting behaviors during childhood and alcohol use during adolescence.

Ocular manifestations of equine motor neuron disease

The characteristics of the ocular manifestations of equine motor neuron disease (EMND) are described. Forty-two horses with histories, clinical signs and necropsies compatible with EMND were the subjects of this study. Ophthalmoscopic lesions that varied in severity were found in 40 of 42 horses and appeared as a distinct pigmented reticulated pattern at the tapetal-nontapetal junction or throughout the fundus, depending upon severity. The pattern colours ranged from yellow brown to black. Areas of hyperreflectivity formed mosaic patterns in the tapetal fundus. ERG B-wave amplitudes were usually at least 50% reduced and many animals showed extinguished amplitudes. None of the horses had apparent visual impairment. Histopathologically, all 42 horses had retinal pigment epithelial (RPE) congestion with ceroid-lipofuscin. Retinal degeneration was variable even within the eyes. Thin layer chromatography (TLC) analysis of the RPE and neural retina identified both green and orange emitting fluorescent compounds not found in normal horses. All unsupplemented horses had plasma vitamin E levels <1.0 microg/ml. The potential significance of this report is the pathognomonic role the ocular manifestations exhibit in helping to diagnose equine motor neuron disease.

Brain-derived neurotrophic factor improves blood glucose control and alleviates fasting hyperglycemia in C57BLKS-Lepr(db)/lepr(db) mice

Systemic administration of brain-derived neurotrophic factor (BDNF) decreases nonfasted blood glucose in obese, non-insulin-dependent diabetic C57BLKS-Lepr(db)/lepr(db) (db/db) mice, with a concomitant decrease in body weight. By measuring percent HbA1c in BDNF-treated and pair-fed animals, we show that the effects of BDNF on nonfasted blood glucose levels are not caused by decreased food intake but reflect a significant improvement in blood glucose control. Furthermore, once established, this effect can persist for weeks after cessation of BDNF treatment. Oral glucose tolerance tests were performed to examine the effects of BDNF on blood glucose control in the fasted state and after an oral glucose challenge. BDNF treatment normalized fasting blood glucose from initially hyperglycemic levels and also showed evidence for beneficial, although less marked, effects on the ability to remove exogenous glucose from blood. One means to lower fasting blood glucose is to reduce the glucose output of peripheral tissues that normally play a part in the maintenance of fasting hyperglycemia. Because the liver is the major endogenous source of glucose in blood during fasting, and because hepatic weight and glucose output are increased in type 2 diabetes, we evaluated the effects of BDNF on liver tissue. BDNF reduced the hepatomegaly present in db/db mice, in association with reduced liver glycogen and reduced liver enzyme activity in serum, supporting the possible involvement of liver tissue in the mechanism of action for BDNF.

Reliability of children's self-reported cigarette smoking

Youth who first smoke cigarettes during childhood are a high risk for habitual smoking. Evaluating the reliability of children's smoking initiation is essential to research efforts to explain or prevent smoking onset. The present study is the first to establish reliability of self-reported smoking behavior with questionnaire data from elementary school children (N = 1,184). Data from a longitudinal investigation are used to examine the consistency of children's self-reported smoking across items and over time. Both cross-sectional and longitudinal analyses demonstrate that children report having tried smoking and lifetime use remarkably consistently. However, only about half the children reliably estimated their grade at first use. The study results suggest that some but not all standard questionnaire items yield reliable self-report data about initial smoking behavior from respondents as young as 8 to 11 years.

The effect of perceived control over eating on the life satisfaction of women and men: results from a community sample

OBJECTIVE

To test whether overweight, or perception of lack of control over eating, or both, contributed to the level of life satisfaction for women and men in a random sample of community-dwelling adults.

METHOD

This study examined the effects of body mass index (BMI) and perceived control over eating on life satisfaction for women and men in a community-based sample of 1,069 women and 963 men.

RESULTS

For women, both lack of perceived eating control and higher BMI were associated with less life satisfaction, and lack of control over eating was the more important predictor. For men, only lack of perceived eating control was associated with less life satisfaction. Furthermore, for both women and men, the contribution of eating control to life satisfaction was unaffected by BMI, that is, the life satisfaction of heavier people was not more affected by perceived control over eating than was the life satisfaction of lighter people.

DISCUSSION

These findings suggest that psychological issues related to eating and weight can affect global aspects of well-being.

Early intervention in psychosis. The critical period hypothesis

BACKGROUND

We consider the evidence for the proposition that the early phase of psychosis (including the period of untreated psychosis) is a critical period in which (a) long-term outcome is predictable, and (b) biological, psychological and psychosocial influences are developing and show maximum plasticity.

METHOD

First-episode prospective studies, predictors of outcome and the genesis of patients' key appraisals of their psychosis are reviewed.

RESULTS

The data support the notion of the 'plateau effect', first coined by Tom McGlashan, which suggested that where deterioration occurs, it does so aggressively in the first 2-3 years; and that critical psychosocial influences, including family and psychological reactions to psychosis and psychiatric services, develop during this period.

CONCLUSIONS

The early phase of psychosis presents important opportunities for secondary prevention. We outline a prototype of intervention appropriate to the critical period. The data challenge the widely held assumption that first-episode psychosis is a benign illness posing little risk.

C-type natriuretic peptide expression and pulmonary vasodilation in hypoxia-adapted rats

Atrial and brain natriuretic peptides (ANP and BNP, respectively) are potent pulmonary vasodilators that are upregulated in hypoxia-adapted rats and may protect against hypoxic pulmonary hypertension. To test the hypothesis that C-type natriuretic peptide (CNP) also modulates pulmonary vascular responses to hypoxia, we compared the vasodilator effect of CNP with that of ANP on pulmonary arterial rings, thoracic aortic rings, and isolated perfused lungs obtained from normoxic and hypoxia-adapted rats. We also measured CNP and ANP levels in heart, lung, brain, and plasma in normoxic and hypoxia-adapted rats. Steady-state CNP mRNA levels were quantified in the same organs by relative RT-PCR. CNP was a less potent vasodilator than ANP in preconstricted thoracic aortic and pulmonary arterial rings and in isolated lungs from normoxic and hypoxia-adapted rats. Chronic hypoxia increased plasma CNP (15 +/- 2 vs. 6 +/- 1 pg/ml; P < 0.05) and decreased CNP in the right atrium (35 +/- 14 vs. 65 +/- 17 pg/mg protein; P < 0.05) and in the lung (3 +/- 1 vs. 14 +/- 3 pg/mg protein; P < 0.05) but had no effect on CNP in brain or right ventricle. Chronic hypoxia increased ANP levels fivefold in the right ventricle (49 +/- 5 vs. 11 +/- 2 pg/mg protein; P < 0.05) but had no effect on ANP in lung or brain. There was a trend toward decreased ANP levels in the right atrium (2,009 +/- 323 vs. 2,934 +/- 397 pg/mg protein; P = not significant). No differences in CNP transcript levels were observed between the two groups of rats except that the right atrial CNP mRNA levels were lower in hypoxia-adapted rats. We conclude that CNP is a less potent pulmonary vasodilator than ANP in normoxic and hypoxia-adapted rats and that hypoxia raises circulating CNP levels without increasing cardiopulmonary CNP expression. These findings suggest that CNP may be less important than ANP or BNP in protecting against hypoxic pulmonary hypertension in rats.

A longitudinal study predicting patterns of cigarette smoking in late childhood

Early initiation of cigarette smoking so strongly predicts future smoking that several investigators have advocated delaying the age of initiation as a prevention strategy. To complement retrospective studies of early initiation, this study assessed prospectively patterns of smoking behavior in a sample of 401 children who were surveyed in the fifth, sixth, and seventh grades. The principal findings were (1) modeling of smoking by parents and friends is sufficient to influence children to initiate smoking, particularly when children also have low behavioral self-control, and (2) when modeling occurs in combination with poor adjustment to school, low parental monitoring, easy access to cigarettes, and other risk attributes, early initiators are significantly more likely to continue smoking. The results suggest that delaying initiation of smoking without also modifying child attributes and socialization factors that predict early initiation and persistent smoking is unlikely to reduce the proportion of children who become habitual smokers.

The Authoritative Parenting Index: predicting health risk behaviors among children and adolescents

Public health research demonstrates increasing interest in mobilizing parental influence to prevent health risk behaviors among children and adolescents. This research focuses on authoritative parenting, which previous studies suggest can prevent health risk behaviors among youth. To evaluate the reliability and validity of a new survey measure of authoritative parenting, data from studies of (1) substance use in a sample of 1,236 fourth- and sixth-grade students; (2) weapon carrying and interpersonal violence in a sample of 1,490 ninth- and tenth-grade students, and (3) anger, alienation, and conflict resolution in a sample of 224 seventh- and eighth-grade students were analyzed. The Authoritative Parenting Index had a factor structure consistent with a theoretical model of the construct; had acceptable reliability; showed grade, sex, and ethnic differences consistent with other studies; and identified parenting types that varied as hypothesized with multiple indicators of social competence and health risk behaviors among children and adolescents.

The Authoritative Parenting Index: predicting health risk behaviors among children and adolescents

Public health research demonstrates increasing interest in mobilizing parental influence to prevent health risk behaviors among children and adolescents. This research focuses on authoritative parenting, which previous studies suggest can prevent health risk behaviors among youth. To evaluate the reliability and validity of a new survey measure of authoritative parenting, data from studies of (1) substance use in a sample of 1,236 fourth- and sixth-grade students; (2) weapon carrying and interpersonal violence in a sample of 1,490 ninth- and tenth-grade students, and (3) anger, alienation, and conflict resolution in a sample of 224 seventh- and eighth-grade students were analyzed. The Authoritative Parenting Index had a factor structure consistent with a theoretical model of the construct; had acceptable reliability; showed grade, sex, and ethnic differences consistent with other studies; and identified parenting types that varied as hypothesized with multiple indicators of social competence and health risk behaviors among children and adolescents.

Molecular characterization of Warthin tumor

OBJECTIVE

Warthin tumor of the salivary gland is composed of oncocytic epithelium with a prominent follicular lymphoid infiltrate. The purpose of this study was to characterize the clonality of this lymphoid component by means of polymerase chain reaction technology.

STUDY DESIGN

DNA was isolated from paraffin-embedded tissue from 20 cases of typical Warthin tumor of the salivary gland and amplified by polymerase chain reaction to assess B- and T-cell clonality.

RESULTS

No dominant clonal populations were identified in any tumor. However, minor clonal expansions of both B and T cells were detected in up to 50% of tumors (immunoglobulin H, 50%; T-cell antigen receptor beta, 10%; T-cell antigen receptor gamma, 5%). No tumors showed evidence of bcl-2 proto-oncogene translocation, whereas 95% contained detectable Epstein-Barr virus DNA.

CONCLUSION

The B- and T-cell components of Warthin tumor are polyclonal with oligoclonal expansion of both T and B cells in some lesions.

Prevention of visual loss. Screening in general practice

BACKGROUND

Diseases such as primary open angle glaucoma, diabetes, strabismus and retinoblastoma have been found to have improved outcome by early investigations. Australian GPs are currently well placed to enhance their role in preventable blindness.

OBJECTIVE

To identify key clinical target areas for the prevention of visual loss and discuss opportunities to address these in everyday general practice.

DISCUSSION

Undertaking visual assessment in both children and adults can have benefits in reducing the incidence of preventable blindness in the community. Upskilling and having protocols to work to can enhance the GP's ability to offer this preventive service.

Anti-smoking socialization: relationship to parent and child smoking status

Anti-smoking socialization is defined as the transmission of knowledge, attitudes, and skills that prepare children to resist smoking. Three types of anti-smoking socialization are studied: parents' communication with children regarding no-smoking rules at home, health risks associated with smoking, and the disciplinary consequences of smoking. Results from a survey of children in 3rd through 8th grades (N = 937) indicate that (a) children from households where one or both parents smoke perceive less anti-smoking socialization than their peers from nonsmoking households; (b) anti-smoking socialization is positively associated with authoritative parenting; (c) children have significantly lower rates of smoking intention and initiation when parents engage in anti-smoking socialization, even if parents currently smoke. The findings offer an encouraging message to all parents Communicating anti-smoking messages may effectively discourage children from smoking.

The experience and satisfaction of women attending breast cancer screening

PURPOSE/OBJECTIVES

To determine women's satisfaction and experience with breast cancer screening and associated factors.

DESIGN

Exploratory, descriptive design.

SETTING

One center of the Ontario Breast Screening Program, a province-wide breast cancer screening program.

SAMPLE

Nonprobability sample of 315 asymptomatic women, age 50 years or older, with no previous history of breast malignancy.

METHODS

Data were collected from the entire sample of 315 women immediately postscreening using a self-report questionnaire and from a subgroup of 256 women by telephone interview at three weeks post-screening.

MAIN RESEARCH VARIABLES

Satisfaction with and intentions and anxiety regarding breast cancer screening.

FINDINGS

Overall, women reported a high level of satisfaction with their screening experience, including respect for privacy, encouragement to ask questions, and provision of information. Two areas of concern that participants identified were mammogram discomfort and fear about radiation risks. At the postscreening interview, women reported that breast screening had relatively little impact on social or physical aspects of their lives, but it did have a positive effect on certain emotional issues, such as their feelings of reassurance, well-being, and relaxation.

CONCLUSION

Since the degree of satisfaction that participants in health services report has been shown to influence attendance patterns, assessing breast screening programs from the perspective of attendees is necessary. Such assessment can identify areas of satisfaction and concern and, thus, provide information for developing interventions aimed at promoting recruitment and retention.

IMPLICATIONS FOR NURSING PRACTICE

As health educators, nurses play an important role in providing breast cancer screening information to women. As well as being knowledgeable about screening guidelines and the benefits of screening, nurses also must recognize women's concerns about radiation risks and pain or discomfort with the procedure and be prepared to provide teaching and support for these women.

Health communication on the Internet: an effective channel for health behavior change?

This article presents a theoretical rationale for using the Internet to conduct persuasive public health interventions. Through an examination of the conceptual bases of persuasion, it is posited that the World Wide Web and other Internet-based resources have many of the characteristics necessary for persuasive communication and may, in fact, constitute a hybrid channel that combines the positive attributes of interpersonal and mass communication. The notion that the Internet features many of the persuasive qualities of interpersonal communication makes it a prime candidate for the application of key behavioral science theories and principles to promote healthier behaviors. The broad reach that the Internet shares with many mass communication channels indicates an economy to Internet-based efforts to communicate with large audiences. It is concluded that if the Internet can be used for persuasive health communication and its reach continues to expand, it is time for public health professionals to explore the design and evaluation of Internet-based interventions directed at health behavior change.

Cognitive susceptibility to smoking and initiation of smoking during childhood: a longitudinal study

BACKGROUND

The earlier the onset of cigarette smoking the greater the risk of addictive smoking. Because smoking initiation is occurring at ever younger ages, early onset of smoking is primarily a childhood phenomenon. In this study cognitive susceptibility to smoking was examined as a risk factor for childhood onset of cigarette smoking. This was the first prospective investigation of cognitive susceptibility to smoking as a predictor of smoking initiation by children.

METHODS

Three annual surveys were completed by 788 children who, at baseline, were in the third or fifth grade and had never puffed on a cigarette.

RESULTS

At baseline, 51% of children had either single or multiple indicators of susceptibility to smoking. Over 2 years, children with single indicators of susceptibility were 80% more likely to initiate smoking, and children with multiple indicators of susceptibility were four times as likely to initiate smoking as nonsusceptible peers. Susceptibility was a stronger predictor of initiation than all other predictors examined, including exposure to family members and friends who smoke cigarettes.

CONCLUSION

Among abstinent children ages 8 to 10 years, cognitive susceptibility to smoking was a significant predictor of whether they initiated smoking prior to adolescence. Reducing children's susceptibility to smoking could strengthen efforts to prevent early onset of cigarette smoking.

Initial and experimental stages of tobacco and alcohol use during late childhood: relation to peer, parent, and personal risk factors

A staged model of smoking adoption has been widely applied in studies of adolescent smoking. The present study applied this model to examine the preliminary stages of tobacco and alcohol use by children. Using discriminant analysis, factors associated with the abstinence, initiation, and experimentation stages of tobacco and alcohol use were compared in a sample of 1,272 children in grades 4 and 6. Modeling of use by best friends and the perceived prevalence of use among same-age peers were most strongly related to the initiation and experimentation stages of tobacco and alcohol use. Other key factors were offers from parents and friends, adjustment to school, and behavioral self-regulation. The weakest factors were parental modeling and self-esteem. The initiation and experimentation stages are not as highly differentiated among children as other studies have found them to be among adolescents, suggesting that if initiation occurs during childhood, progression to experimentation is likely. Prevention programs could simultaneously influence children's risk of tobacco and alcohol use by targeting the common risk factors for preliminary use of these substances.

Behind the bare statistics

The findings of the Mental Health Care stress survey will come as no surprise to nurses working on the front-line. But the statistics tell only half the story.

Relative efficacy of haloperidol and pimozide in children and adolescents with Tourette's disorder

OBJECTIVE

The authors evaluated the relative efficacy and safety of pimozide and haloperidol in the treatment of Gilles de la Tourette's syndrome in children and adolescents.

METHOD

A double-blind, 24-week, placebo-controlled double crossover study of equivalent dose formulations of haloperidol and pimozide was conducted with 22 subjects, aged 7-16 years, with Tourette's disorder who were randomly assigned to first one active drug treatment and then the other. Biweekly assessment and flexible dose titration mimicked clinical practice. The primary outcome variable was total score on the Tourette Syndrome Global Scale. Final outcome was determined after 6 weeks of each treatment (placebo, pimozide, haloperidol), with a 2-week placebo baseline period and intervening 2-week placebo washout periods between treatments.

RESULTS

Pimozide proved significantly different from placebo in affecting the primary outcome variable, whereas haloperidol failed to have a significant effect. Haloperidol exhibited a threefold higher frequency of serious side effects and significantly greater extrapyramidal symptoms relative to pimozide. Haloperidol-associated treatment-limiting adverse events were experienced by 41% of the patients. The therapeutic doses of pimozide and haloperidol were equivalent (mean = 3.4 mg/day, SD = 1.6, and mean = 3.5 mg/day, SD = 2.2, respectively).

CONCLUSIONS

At equivalent doses, pimozide is superior to haloperidol for controlling symptoms of Tourette's disorder in children and adolescents.

Does psychological testing help to predict the response to acupuncture or massage/relaxation therapy in patients presenting to a general neurology clinic with headache?

Patients with chronic headache were offered treatment by acupuncture or massage with relaxation instead of a change in their prescribed medication. They were randomly allocated to either treatment. There was a significant improvement in pain ratings with both treatment types. Specifically a greater effect was seen in migraine patients treated by massage with relaxation when compared to acupuncture. No psychological factors were found to predict response to either treatment. At the end of the study, 13% of patients were significantly more worried that there may be a more serious cause underlying their headache despite reassurance and an improvement in their headache scores.

Efficacy of antimigrainous therapy in the treatment of migraine-associated dizziness

OBJECTIVE

To assess the effects of antimigrainous therapy on migraine-associated dizziness/vertigo. We hypothesized that a medication's ability to ameliorate dizziness/vertigo in this patient population would be directly correlated with its efficacy in improving headache symptoms.

STUDY DESIGN

Patient survey.

SETTING

Patients were entered into the study from the University of California, San Diego (UCSD) Headache Clinic, a tertiary care referral clinic.

PATIENTS

All patients presenting to the UCSD headache clinic are entered into its comprehensive database. Patients who identified dizziness or vertigo as symptoms were entered into this study and were surveyed.

MAIN OUTCOME MEASURES

Patients were surveyed as to the nature of their vestibular symptoms, and the therapeutic response of these symptoms and their headaches to various antimigrainous medications. Patients were asked to rank therapeutic efficacy utilizing a numeric scale. These results were then subjected to statistical analysis (Spearman rank correlation) to identify any correlation between the efficacies of the medications in improving headache and dizziness/vertigo.

RESULTS

The efficacy of the medications in treating migraine-associated dizziness was directly correlated with their ability to alleviate headaches.

CONCLUSION

We conclude that antimigrainous therapy may offer specific treatment to patients suffering from the spectrum of migraine-associated vestibular disorders. This would include the entity known alternately as vestibular Meniere's disease, benign recurrent vertigo, or recurrent vestibulopathy. Given the potential benefits that may be derived from this therapy, clinicians should be sensitive to a history of migraines in patients complaining of dizziness, particularly in those complaining of recurrent episodic vertigo.

Dopamine agonist treatment of Tourette disorder in children: results of an open-label trial of pergolide

This exploratory study was meant to determine the effect of the dopamine (DA) agonist pergolide on Gilles de la Tourette syndrome (GTS) in children and adolescents and to ascertain correlates of pergolide response. Thirty-two outpatients, aged 7-19 years, were systemically assessed in a neuropsychiatric clinic for the presence of GTS and comorbid disorders. After a 6-week open-label, fixed-flexible dosing schedule, response to pergolide on standard GTS severity outcome measures was assessed. Overall, 75% of patients (24/32) had a > 50% drop in their tic severity rating from baseline with a mean treatment dosage of 177 +/- 61 micrograms/day. Highly significant (p = 0.0001) baseline to week 6 differences were demonstrated in all tic symptom measures. The presence of restless legs syndrome (RLS) comorbidity (59%) was highly associated with a positive response. These results suggest DA agonism as a strategy, and pergolide in particular, may be a practical form of therapy for GTS. Response predictors of patient comorbid RLS argue for its further study with regard to GTS.

GPs and eye skills. A brave new world?

OBJECTIVE

To evaluate the efficacy of a brief general practitioner eye upskilling intervention to enhance GP eye skills and increase their use in clinical practice.

METHOD

Seventeen GPs from a Brisbane Division of General Practice were recruited to participate in a 7 hour clinical upskilling intervention, delivered over an 8 week period.

RESULTS

The proportion of GPs able to accurately recognise glaucomatous fundal damage on clinical assessments rose from 24.0 to 54.2% (standard error [SE] 3.96). The proportion able to accurately recognise diabetic fundal disease on clinical assessment rose from 30.8 to 54.1% (SE 9.2). The ability to recognise fundal disease on slide presentations rose on average from 27.1 to 67.5% (SE 10.8). Although none of the practitioners were able to perform oculokinetic perimetry at the beginning of the intervention, all were able to accurately perform it at the conclusion of the intervention.

CONCLUSION

GPs are capable of rapidly upskilling in important areas of ocular assessment involving preventable blindness.