Setting the scene: a scoping review of gambling research in Ghana

Ghana, like many other African countries, has seen a rapid expansion in gambling industry activity in the last decade with sports betting becoming a popular pastime among young Ghanaian males. The proliferation of land based, and online gambling operations presents a significant public health threat to the citizenry. Yet little is known about gambling participation and harms, the size of the gambling market and the role of the gambling industry in influencing and perpetuating gambling behaviour in Ghana. The aim of this study was to contribute to understanding the extent of gambling research in Ghana by mapping out what the current literature indicates. Six databases were searched for peer-reviewed journal articles that focused on gambling in Ghana. The findings from this review demonstrate gambling research in Ghana is in a nascent state with a predominant focus on individual factors and limited consideration of public health. The implications for future research are highlighted, including the requirement for a nationally representative study to understand the prevalence of gambling participation and harm, and the role of the gambling industry. Public health action grounded in sound evidence is urgently required to address the individual and community level problems associated with this harmful commodity.

Factors of the policy process influencing Health in All Policies in local government: A scoping review

Objectives

This review aimed to identify factors in the policymaking environment that influence a Health in all Policies approach in local government, how these vary across different municipal contexts, and the extent that theories of the policy process are applied.

Methods

A scoping review was conducted to include sources published in English, between 2001 and 2021 in three databases, and assessed for inclusion by two blind reviewers.

Results

Sixty-four sources were included. Sixteen factors of the policy process were identified, expanding on previously reported literature to include understanding and framing of health, use of evidence, policy priority, and influence of political ideology. Eleven sources applied or referred to theories of the policy process and few reported findings based on different local government contexts.

Conclusion

There are a range of factors influencing a Health in All Policies approach in local government, although a limited understanding of how these differ across contexts. A theory-informed lens contributed to identifying a breadth of factors, although lack of explicit application of theories of the policy process in studies makes it difficult to ascertain meaningful synthesis of the interconnectedness of these factors.

Utilizing Causal Loop Diagramming to Explore a Research and Evaluation Capacity Building Partnership

The capacity to engage in research, evaluation and evidence-informed decision-making supports effective public health policy and practice. Little is known about partnership-based approaches that aim to build capacity across a system or how to evaluate them. This study examines the impacts of a research and evaluation capacity building partnership called the Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (hereafter, SiREN). SiREN aims to strengthen capacity across a system of clinical and medical services and government and non-government organizations. These organizations are connected through their shared aim of preventing and managing sexually transmissible infections and blood-borne viruses. To examine SiREN, systems concepts and methods were used. Data were collected from SiREN organizational documents (n = 42), a survey tool (n = 104), in-depth interviews (n = 17), a workshop and three meetings with SiREN stakeholders and used to develop two causal loop diagrams. Findings show engagement with SiREN was influenced by a complex interplay of contextual (e.g., organizational capacity) and process (e.g., presence of trusting relationships) factors. SiREN contributed to system level changes, including increased resources for research and evaluation, the development of networks and partnerships that led to more efficient responses to emerging health issues, evidence sharing, and sustainable research and evaluation practice. The use of causal loop diagrams enabled the identification of key leverage points that SiREN can use for continuous improvement or evaluation. The focus on how contextual factors influenced SiREN's ability to create change provides valuable information for researchers, policymakers or practitioners seeking to develop a similar partnership.

'It is stigma that makes my work dangerous': experiences and consequences of disclosure, stigma and discrimination among sex workers in Western Australia

Western Australia criminalises sex work whilst some other Australian jurisdictions have decriminalised the industry. This article examines the role of Western Australia's legislation in reinforcing stigma and discrimination of sex workers. It draws on stigma and discrimination-specific results from open-ended survey responses and interview data collected as part of a larger cross-sectional mixed-methods study. Experiences and/or anticipation of stigma and discrimination resulted in some sex workers concealing their involvement in sex work from family, friends and their home communities. This was a major barrier to accessing health care and protective services and impacted negatively on their mental health and wellbeing. There is a need for policy change and support to shift society's perception of sex work to that of a legitimate occupation to decrease sex workers' experiences of stigma and discrimination and improve their access to and utilisation of health care and protective services. These findings highlight the need for the decriminalisation of the Western Australian sex industry and the development of training programmes for police and healthcare workers to reduce the stigma and discrimination experienced by sex workers in these settings.

Framing the nanny (state): an analysis of public submissions to a parliamentary inquiry on personal choice and community safety

OBJECTIVE

To examine public submissions to a parliamentary inquiry on personal choice and community safety, exploring framing used to support or oppose current public health regulatory approaches.

METHODS

Descriptive content analysis summarised the characteristics of electronic submissions. Framing analysis examined submissions according to the devices: problem and causes; principles and values; recommendations; data and evidence; and salience.

RESULTS

We categorised one hundred and five (n=105) submissions by source as Individual, Industry, Public Health and Other. Individuals made more than half the submissions. Overarching frames were choice and rights (Individuals); progress and freedom (Industry); protection and responsibility (Public Health). Most submissions opposed current regulations. Cycling, including mandatory helmet legislation, was most cited, with three-quarters of submissions opposing current legislation.

CONCLUSIONS

Framing analysis provided insights into policy actor agendas concerning government regulation. We found a high degree of resistance to public health regulation that curtails individual autonomy across various health issues. Investigating the influence of different frames on community perception of public health regulation is warranted. Implications for public health: Action is required to counteract 'nanny state' framing by industry and to problematise community understanding of the 'nanny state' in the context of balancing the public's liberties and the public's health.

Sex workers as peer researchers - a qualitative investigation of the benefits and challenges

Best practice in sex work research advocates for a 'nothing about us without us' methodology. This study employed sex workers as peer researchers to assist in evaluating the sexual health outcomes and well-being of sex workers in Western Australia. All eight peer researchers were invited to reflect on their experiences as peer researchers through semi-structured interviews, and seven peer researchers participated. Giving sex workers a voice and the opportunity to facilitate change for their peers was the primary driver for participation. Some peer researchers from English speaking backgrounds experienced challenges engaging and communicating with study participants for whom English was not their first language. Others experienced role conflict on hearing viewpoints contrary to their own beliefs. Access to support from the project team and other peer researchers was a key enabler for undertaking the peer researcher role. The majority of peer researchers were motivated to participate in the research by the possibility of future changes to sex work-related legislation, and support for sex workers based on the research findings. Research partnerships with peer researchers that offer employment throughout the research process, including co-authorship of journal articles, opportunities for leadership roles and collaboration in research translation activities can increase research impact.

Sex Worker Health Outcomes in High-Income Countries of Varied Regulatory Environments: A Systematic Review

There is significant debate regarding the regulation of the sex industry, with a complex range of cultural, political and social factors influencing regulatory models which vary considerably between and within countries. This systematic review examined the available evidence on the relationship between different approaches to sex industry regulation in high-income countries, and associated effects on sex worker health status. Objectives included identification of sex worker health outcomes, including sexual health, substance use and experience of stigma and violence. A search was performed electronically in eight scholarly databases which yielded 95 articles which met the criteria for inclusion. Findings suggested that sex workers in legalised and decriminalized countries demonstrated greater health outcomes, including awareness of health conditions and risk factors.

Insights into local health and wellbeing policy process in Australia

To investigate factors that enable or challenge the initiation and actioning of health and wellbeing policy in Australian local governments using political science frameworks. An online survey was distributed to staff and elected members of Australian local governments. The survey sought responses to a range of variables as informed by political science frameworks. Data were analysed using descriptive statistics and results were compared between local governments of different geographical sizes and locations using Kruskal-Wallis non-parametric testing. There were 1825 survey responses, including 243 CEOs, representing 45% of Australian local governments. Enablers for local government policy initiation and action included the high priority given to health and wellbeing (44%), local leadership (56%) and an organizational (70%) and personal obligation (68%) to the community to act. Less true is a favourable legislative environment (33%), leadership from higher levels of government (29%) and sufficient financial capacity (22%). Cities are better positioned to initiate and action health policy, regardless of the broader legislative environment. Health and wellbeing is a high priority for Australian local governments, despite lack of funding and limited lobbying and support from other sectors and higher levels of government. The insights from political science frameworks assist to understand the policy process, including the interrelatedness of enablers and challenges to initiating and actioning health and wellbeing policy. Further understanding the policy drivers would support practitioners and researchers advocating to influence local health and wellbeing policy.

A snapshot of male sex worker health and wellbeing in Western Australia

Background There is limited information available about the health and wellbeing of male sex workers in Australia and globally. This study therefore was conducted to survey male sex workers in Western Australia as part of a broader study investigating the health and safety of sex workers in Western Australia.

METHODS

Male sex workers were surveyed using a modified survey instrument that had been used in a study undertaken in 2006. Survey respondents were recruited by word-of-mouth, social media, advertisements in gay press and in person. In-depth interviews with a small number of male sex workers were also conducted.

RESULTS

Fifty-eight men responded to the survey. The majority of survey respondents (42/58, 72%) were aged ≤35 years and a high proportion (50/58, 86%) worked privately at least some of the time. Seventy-two per cent (33/46) reported consistently using condoms during anal sex and 22% (11/51) during oral sex with clients. The consistent use of condoms with partners outside of work was associated with consistent use of condoms with clients. Forty per cent (23/58) of respondents reported currently using tobacco and 47% (25/53) reported harmful drinking at least weekly. The majority of respondents reported that sex work enhanced their wellbeing, with negative effects being largely due to stigma and discrimination, and the uncertainty related to not having a steady income.

CONCLUSION

The study findings point to the need for peer outreach and support, interventions to improve the broader health of male sex workers and decriminalisation of sex work in Western Australia.

Measuring health promotion research impact - What researchers think?

ISSUES ADDRESSED

The significant investment in health research has resulted in an increased focus to determine suitable approaches to measure health promotion research impact. This research was undertaken at the request of a nationally competitive research organisation that funds health promotion research, to explore how Chief Investigators (CIs) on their funded projects understood research impact, its measurement and associated challenges.

METHODS

Participants were required to be or have been a CI on an Australian competitive research (exploratory or intervention) grant focussed on health promotion. The qualitative study used thematic analysis from one-on-one interviews. Themes were created and descriptive quotes were selected to illustrate the main findings.

RESULTS

The majority of participants were female (n = 13) working at a university (n = 13). Three themes emerged: a) defining health research impact; b) complexity and simplicity of measuring health research impact; c) challenges of measuring health research impact: i) differing language; ii) differing assessment; iii) attribution and timing; and iv) resourcing and skills.

CONCLUSION

Researchers recognised that there are significant challenges in measuring the impact of health promotion research. The most significant factors identified by participants were the disciplinary background of the researchers undertaking the measurement, their skills and experience and the resources (including time) available to assess impact. SO WHAT?: Research impact assessment is complex, time consuming and requires specific skills to facilitate measurement of impact provision of funding for this activity in research grants and research impact training is required.

Risk perceptions, misperceptions and sexual behaviours among young heterosexual people with gonorrhoea in Perth, Western Australia

Background

Notification rates of gonorrhoea in Australia for heterosexual young adults rose by 63% between 2012 and 2016. In Western Australian major cities, there was a 612% increase among non-Aboriginal females and a 358% increase in non-Aboriginal males in the ten-year period 2007-2016. A qualitative public health investigation was initiated to inform appropriate action.

Methods

Eighteen semi-structured telephone interviews were conducted with non-Aboriginal heterosexual young adults aged 18-34 years living in Perth, Western Australia, who had recently been notified to the Department of Health with gonorrhoea, to explore the context of their sexual interactions and lifestyles which could have predisposed them to contracting gonorrhoea. Data were thematically analysed.

Results

Common themes were having several casual sexual partners, limited communication between sexual partners about condom use or sexual history prior to engaging in sexual activity, inconsistent condom use, normalisation of some sexually transmissible infections amongst young people, and poor understandings and assessment of sexually transmissible infection risk.

Conclusion

The findings support public health interventions that focus on communication between sexual partners and shifting of risk perceptions in sexual health education programs, ensuring accessibility of quality sexual health information, increasing condom accessibility and acceptability, and on strategies for addressing misperceptions of young people in relation to sexually transmitted infections.

Alcohol consumption and associated harms among university students in Australia: Findings from a cross-sectional study

ISSUE ADDRESSED

University students regularly report alcohol consumption in excess of Australian guidelines for harm. However, previous studies have overlooked the experiences of mature-aged students. This study assessed alcohol consumption and alcohol-related harms among university students aged 18-50 years old in Australia.

METHODS

A cross-sectional online survey with convenience sample of university students was used in this study. Unadjusted ordinal logistic regressions were performed to explore associations between student characteristics and frequency of alcohol consumption as well as number of standard drinks consumed. Logistic regressions adjusted for student characteristics were performed to assess associations between alcohol consumptions and alcohol-related harm.

RESULTS

Of the respondents (n = 486), 82% consumed alcohol, of which 50% consumed more than two standard drinks on any day. Age was significantly associated with amount consumed and blackout. Students aged 31-50 years were less likely to consume more than two standard drinks on any day (odds ratio, OR: 0.62, 95% confidence interval (95% CI): 0.40, 0.97); and less likely to experience blackout (OR: 0.45; 95% CI: 0.25, 0.83) than those aged 18-20 years. Interestingly, reducing consumption to no more than once a month, when compared to more than twice a month, reduced risk of blackout only for those aged less than 31-50 years old (adjusted OR: 0.22; 95% CI: 0.04, 1.13).

CONCLUSIONS

Older university students are less likely to drink more than two standard drinks on any day than their younger counterparts. SO WHAT?: It is recommended that interventions target younger students; however, older students may assist in understanding factors that influence low risk alcohol consumption.

University Student Health and Wellbeing Study: A test-retest reliability study of a web-based survey investigating undergraduate student health and wellbeing

ISSUE ADDRESSED

Understanding the health behaviours of Australian university students and their impact on wellbeing and academic success is important; however, there are limited reliable, population level survey tools to measure student health across a range of domains. The purpose of the research was to determine the reliability of the web-based University Student Health and Wellbeing Study (USHWS) survey via a test-retest reliability study within a large Australian university student population.

METHODS

A test-retest of the measurement instrument was completed by a sample of university students (n = 195) over a two-week period. The instrument assessed alcohol and tobacco use, mental health, sexual health, physical activity, nutrition and sun protective behaviours. Test-retest reliability was analysed using two-way random effects model of intraclass correlations (ICC) and AC₁ coefficient for individual measurements with 95% confidence intervals (95% CI).

RESULTS

Questions on demographics, general health, nutrition, sun protection, alcohol and tobacco use, mental health and sexual health had fair to high reliability (ICCs range from 0.32 to 1.00). Reliability of some physical activity items were poor with large variability (ICC = 0.15, 95% CI 0.01-0.28 to 0.86, 95% CI 0.82-0.89).

CONCLUSIONS

A majority of the USHWS survey items represented a moderate to high test-retest reliability. Variability and poor reliability of physical activity questions may be due to survey implementation time and usual behaviour changes. SO WHAT?: The USHWS survey is reliable instrument to assess Australian university student health at a population level with the aim of informing effective programming, policy and initiatives.

SUMMARY

The University Student Health and Wellbeing Study (USHWS) survey is a foundational tool to understand university student's health in Australia. The USHWS reported fair to high reliability with few physical activity items showing lower reliability. Greater variability may be due to usual day-to-day fluctuations in behaviour.

Taking a systems approach to explore the impacts and outcomes of a research and evaluation capacity building partnership: a protocol

INTRODUCTION

Partnership models that bring researchers, policymakers and service providers closer together are gaining traction as a strategy to improve public health practice. Yet, there is little evidence of how these models work, or indeed if they do work. The Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) is one such model. SiREN is a partnership between researchers, policymakers and service providers that aims to develop the research and evaluation capacity and evidence-informed decision making capability of professionals working to address sexual health and bloodborne virus issues in Western Australia. This study will use a systems approach to identify the mechanisms of action, impacts and outcomes of SiREN and inform the development of evaluation tools.

METHODS AND ANALYSIS

Data will be collected from organisational documents, surveys, in-depth interviews and a workshop. It will be analysed using a complex adaptive systems lens and findings will be used to inform the development of a type of qualitative systems model called a causal loop diagram. The causal loop diagram will illustrate the: contextual factors influencing engagement; mechanisms of action; and impacts and outcomes of SiREN. Evaluation tools will then be developed that can be used to assess the indicators identified in the causal loop diagram.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Curtin University Human Research Ethics Committee (approval number: HRE2017-0090). Participants will be free to withdraw from the study at any point and confidentiality will be maintained by de-identifying participant responses in any published or shared data. The findings from this study will be shared in conference presentations, reports, peer-reviewed journals and online through websites and social media.

The injury workforce in Western Australia: Findings from a cross-sectional survey

ISSUE ADDRESSED

Since 1986, injury prevention and control has been classified as a National Health Priority. However, no reviews into the injury prevention workforce have been conducted in Australia since 2011 and to date; none has focused specifically on the injury prevention and safety promotion sector in Western Australia (WA). This research sought to review the scope of the injury prevention and safety promotion workforce in WA to gain a greater understanding of sector characteristics, work and needs.

METHODS

An online, cross-sectional survey was conducted between mid-January and mid-March 2018. Participants were required to be: (a) based in WA or have a program running within WA; and (b) working in injury prevention and safety promotion relating to programs, policy or legislation development, implementation and/or evaluation within intentional (eg interpersonal violence, suicide and self-harm) or unintentional injuries (eg transport, poisoning, falls, drowning, burns) or farm, child and community, occupational health and safety, sport and recreation and trauma.

RESULTS

The research found that participants were predominantly female (82%), aged 40 years or older (66.1%) and were employed full time (55.6%). The majority of participants worked in falls prevention (38.5%), alcohol and other drugs (38.0%), injury in general (31.8%) and community safety (30.7%).

CONCLUSIONS

Findings demonstrate significant heterogeneity with a core workforce supported by a range of non-core and indirect actors. Identifying characteristics and needs of the workforce supports coordinated capacity building to implement effective injury prevention and safety promotion initiatives. With this being the first review of the workforce in WA, this article highlights the need to more regularly audit the sector to determine its breadth and composition. SO WHAT?: In the light of the recent announcement by the Commonwealth for a new national Injury Prevention Strategy, this study provides timely insights into the injury prevention and safety promotion sector in WA.

Declining Condom Use Among Sex Workers in Western Australia

Introduction: Since the emergence of the HIV pandemic in the 1980s, high rates of condom use for penetrative sex have been reported among sex workers in Australia. The sex industry in Australia and elsewhere has changed over the previous decade with increasing proportions of sex workers working privately and lower proportions of sex workers working in brothels. There has also been some evidence of reductions in condom use, particularly during penetrative oral sex. We therefore decided to investigate sex workers' use of condoms during penetrative sex with clients.

Methods: This was a cross-sectional mixed methods study of sex workers in Western Australia. The study involved an environmental scan of the sex industry in Western Australia, visits to brothels and other sexual services premises, a survey of sex workers and in-depth interviews.

Results: We surveyed 354 male, female, and transgender sex workers in Western Australia. We found unexpectedly low rates of reported condom use with clients for all forms of penetrative sex. Of respondents who reported providing this type of service, 33% reported that all clients used condoms during oral sex, 69% during vaginal sex and 59% during anal sex. High levels of client demand for condomless sex was also reported, with 42% of sex workers reporting that all or most clients requested condomless oral sex. Increasing client demand, fear of losing clients and the ability to charge more for condomless sex were reported reasons for providing this service.

Conclusions: There has been an apparent increase in sex workers reporting condomless penetrative sex with clients in Western Australia compared to a previous cross-sectional study. An increase in private sex work and client demand for condomless sex together with an economic downturn leading to increased competition for clients may be important contributing factors.

Challenges Facing Asian Sex Workers in Western Australia: Implications for Health Promotion and Support Services

Introduction: Asian sex workers are a significant part of the Australian sex industry. Criminal laws, racism, isolation, poor English language skills and stigma and discrimination combine to increase the vulnerability of Asian sex workers in Australia. To inform service delivery and potential legislative reform, we undertook a study of sex worker health and safety in Western Australia with a focus on Asian sex workers.

Methods: This was a mixed methods study in which peer researchers played an essential role. We undertook a survey (available online and in paper form and translated into three languages other than English), semi-structured interviews with sex workers, and interviews with key advisors.

Results: In our study, Asian sex workers were older, had lower levels of education, more likely to have sex work as their main source of income, work longer hours and work exclusively in a shop-front massage parlor compared to their non-Asian counterparts. The vast majority of Asian sex workers in our study said they had poor English language skills and the greatest proportion spoke Chinese languages. Sex work had a positive impact on the well-being of many respondents, and their level of psychological distress was similar to the general Australian population. Stress and “bad clients” were common negative impacts of sex work. Asian study participants were less likely than their non-Asian counterparts to smoke, undertake risky drinking or use illicit drugs. A similar proportion of Asian sex workers reported being assaulted compared to their non-Asian counterparts.

Discussion/Conclusion: The major challenges facing Asian sex workers in WA seem to be stigma and discrimination, stress, social isolation, and confusion about their legal standing leading to a fear of authorities, particularly the police. Our findings support the need for enhanced targeted peer-based health promotion outreach services for Asian sex workers, increased Asian language services in sexual health clinics and decriminalization of sex work.

Changing Communities, Changing Spaces: The Challenges of Health Promotion Outreach in cyberspace

This article is a case study of an Internet chat room outreach project in Perth, Western Australia. The CyberReach project sought to adapt current peer based health promotion outreach, training and supervision frameworks to an online outreach setting in a way that was effective and supported by the online community. It targeted marginalised groups to trial the provision of online mental and sexual health promotion incorporating a participatory action research model into its development and implementation. Three 6-week trial periods were conducted and significant changes were made in response to changes in the online environment and to improve sustainability and effectiveness of the protocols. Four themes arose from CyberReach's experience: online group processes are unique due to the creation of extensive personal networks and occurrence of disclosure without face-to-face contact across potentially large geographic barriers; flexibility is required to adapt to technological changes and online community flux; enforcing boundaries and delineating peer education from therapeutic support can be challenging when only using text-based communication; and Internet outreach can be time intensive with small returns in actual community engagement and constant technological up-skilling of staff may be required. Based on the project's experiences we offer the following recommendations when planning similar Internet outreach strategies: Funding and planning groups need to be aware that the Internet environment is constantly changing and planning and funding arrangements need to reflect a capacity to remain flexible; Programs need to be firmly connected to the communities they are outreaching therefore a peer-based education component is strongly encouraged; Careful consideration should be taken regarding data collection so that the environment and the individuals within are respected; Further research needs to be conducted to understand the styles and approaches of different online interactions, and the relative influence of technical platforms, gender and age.

A research and evaluation capacity building model in Western Australia

Evaluation of public health programs, services and policies is increasingly required to demonstrate effectiveness. Funding constraints necessitate that existing programs, services and policies be evaluated and their findings disseminated. Evidence-informed practice and policy is also desirable to maximise investments in public health. Partnerships between public health researchers, service providers and policymakers can help address evaluation knowledge and skills gaps. The Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) aims to build research and evaluation capacity in the sexual health and blood-borne virus sector in Western Australia (WA). Partners' perspectives of the SiREN model after 2 years were explored. Qualitative written responses from service providers, policymakers and researchers about the SiREN model were analysed thematically. Service providers reported that participation in SiREN prompted them to consider evaluation earlier in the planning process and increased their appreciation of the value of evaluation. Policymakers noted benefits of the model in generating local evidence and highlighting local issues of importance for consideration at a national level. Researchers identified challenges communicating the services available through SiREN and the time investment needed to develop effective collaborative partnerships. Stronger engagement between public health researchers, service providers and policymakers through collaborative partnerships has the potential to improve evidence generation and evidence translation. These outcomes require long-term funding and commitment from all partners to develop and maintain partnerships. Ongoing monitoring and evaluation can ensure the partnership remains responsive to the needs of key stakeholders. The findings are applicable to many sectors.

Twenty years of capacity building and partnership: A case study of a health promotion scholarship program

ISSUE ADDRESSED

Building health promotion workforce capacity and infrastructure is critical to ensure a strong evidence base for effective interventions, sustainability and ultimately positive health outcomes for the community. Accordingly, there is a need to build workforce capacity by providing pathways into the health promotion sector with opportunities for core health promotion competency development. Currently, there is a lack of transition programs and graduate-specific positions in health promotion.

METHODS

This study presents a descriptive case study of a 20-year health promotion scholarships program administered by the Australian Health Promotion Association (WA Branch) and Healthway for health promotion graduates and Aboriginal health workers. Scholarship recipients and supervisors reported on demographics, projects and perspectives on the value of participating in the program.

RESULTS

More than 2 million dollars has been invested to provide health promotion career pathways in WA via 100 scholarships. Key themes relating to program value included as follows: practical application of theoretical concepts; reciprocity; and building skills and capacity in both recipients and supervisors.

CONCLUSIONS

The scholarships program results in a number of benefits to the recipient, host organisation and the overall health promotion sector and is an example of long-term investment to build health promotion capacity with potential for replication. SO WHAT?: Investment in competency-driven health promotion scholarships to create dedicated health promotion career pathways for new practitioners contributes to the capacity of an effective health promotion workforce.

What's wrong with John? a randomised controlled trial of Mental Health First Aid (MHFA) training with nursing students

BACKGROUND

The prevalence of mental health problems have been found to be higher among university students compared to their non-student peers. Nursing students in particular face a range of additional stressors which may impact their undergraduate performance and their careers. Mental Health First Aid (MHFA) aims to increase mental health literacy and to reduce stigma and may positively impact on the student population. This paper describes a MHFA randomised controlled trial targeting nursing students at a large Australian university. This study aimed to measure the impact of the MHFA course on mental health literacy, mental health first aid intentions, confidence in helping someone with a mental health problem and stigmatising attitudes including social distance.

METHODS

Participants were first year nursing students (n = 181) randomly allocated to the intervention (n = 92) or control (n = 89) group. Intervention group participants received the standardised MHFA course for nursing students. Online self-report questionnaires were completed at three time intervals: baseline (one week prior to the intervention: T₁) (n = 140), post intervention (T₂) (n = 120), and two months post intervention (T₃) (n = 109). Measures included demographics, mental health knowledge, recognition of depression, confidence in helping, mental health first aid intentions and stigmatising attitudes including social distance. Repeated measures ANOVA was computed to measure if the impact of time (T₁, T₂, T₃) and group (intervention and control) on the outcome variables.

RESULTS

There was a significant improvement among intervention compared to control group participants across the three time periods for knowledge scores (p < 0.001), confidence in helping (p < 0.001), mental health first aid intentions (p < 0.001), total personal stigma (p < 0.05), personal dangerous/unpredictable stigma (p < 0.05) and social distance (p < 0.05) scores.

CONCLUSION

MHFA is useful training to embed in university courses and has the potential to enhance mental health literacy and reduce stigmatising attitudes and social distance. While this course has particular salience for nursing and other health science students, there are broader benefits to the general university population that should be considered and opportunities accordingly explored for all students to complete the course.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614000861651 . Retrospectively registered 11 August 2014.

'Making the invisible visible' through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study

BACKGROUND

Screening and brief interventions (SBI) for alcohol related problems have been shown to be effective in health settings such as general practice or emergency departments. Recent data from the United Kingdom and New Zealand suggest that SBI can be delivered through community pharmacies, but this approach has not been tested in Australia. This study assesses the feasibility of delivering alcohol SBI via community pharmacists.

METHOD

We recruited five pharmacies and developed an SBI training package to be delivered by pharmacy staff, who screened consumers and delivered the brief intervention where appropriate. Consumers also completed a questionnaire on the process. At three months consumers were telephoned to enable 'retention' to be quantified. After completing recruitment, a semi-structured interview was conducted with pharmacists on the process of delivering the intervention, potential improvements and sustainability.

RESULTS

Fifty consumer participants were screened, ten from each pharmacy. There were 28 (57 %) men and 21 (43 %) women with one not responding. Most (67 %) were aged 25-55 years. Their AUDIT scores had a range of 0 to 39 (mean 10.9, SD 9.8) with 11 categorised as 'hazardous (8-15)', four as 'harmful (16-19)' and eight as 'probably dependent (20+)' consumers of alcohol. Reactions to the process of SBI were generally favourable: for example 75 % agreed that it was either appropriate or very appropriate being asked about their alcohol consumption. With respect to follow-up interviews, 23 (46 %) agreed that they could be contacted, including five from the highest AUDIT category. Subsequently 11 (48 %) were contactable at three months. Three of the five non-low risk drinkers had reduced their level of risk over the three months. Ten pharmacists participated in semi-structured telephone interviews. Overall these pharmacists were positive about the intervention and five main themes emerged from the interviews: 1) flexibility applied in recruitment of participants, 2) easiness in use of AUDIT score to facilitate discussions, 3) perceived positive intervention impact, 4) enhanced role of community pharmacists and 5) facilitators and challenges experienced.

CONCLUSIONS

Pharmacy-based SBI appears to be acceptable to consumers and feasible for pharmacy staff to deliver. Challenges remain in translating this potential into actual services.

Back pain beliefs in adolescents and adults in Australasia: A cross-sectional pilot study of selected psychometric properties of paper-based and web-based questionnaires in two diverse countries

BACKGROUND

It is unknown whether questionnaires measuring psychosocial constructs related to low back pain (LBP) that were originally designed for adults are suitable for adolescents, and if paper and web-versions have similar measurement properties.

OBJECTIVES

To examine selected psychometric properties for the paper- and web-based Back-Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ-phys) among adults and adolescents in two diverse countries and to determine whether differences existed between countries and pain groups.

METHODS

A sample of 156 adults (Hong Kong, n= 75; Australia, n= 81) and 96 adolescents (Hong Kong, n= 61; Australia, n= 35) participated in this cross-sectional study.

RESULTS

Main effects for country and administration mode were observed in adult BBQ scores, where Australian adults reported significantly higher BBQ scores than Hong Kong adults (mean difference (MD); 95% CI: 2.85; 0.96-4.74) and significantly higher scores were recorded on the web mode compared to the paper mode (MD 0.74; 0.10-1.38). Similarly, Hong Kong adults and adolescents reported higher FABQ-phys scores than Australian adults and adolescents (MD; 95% CI: 3.40; 1.37-5.43 and 4.88; 0.53-9.23, respectively). Internal consistency values were mostly acceptable (α ≥ 0.7).

CONCLUSION

Differences exist between cultures for LBP-related beliefs. The BBQ and FABQ-phys have acceptable measurement properties in both administration modes.

A cross sectional evaluation of an alcohol intervention targeting young university students

Background

Hazardous drinking has been found to be higher among young university students compared to their non-university peers. Although young university students are exposed to new and exciting experiences, including greater availability and emphasis on social functions involving alcohol there are few multi strategy comprehensive interventions aimed at reducing alcohol-related harms.

Methods

Random cross sectional online surveys were administered to 18–24 year old students studying at the main campus of a large metropolitan university in Perth, Western Australia. Prior to the completion of the second survey an alcohol intervention was implemented on campus. Completed surveys were received from 2465 (Baseline; T1) and 2422 (Post Year 1: T2) students. Students who consumed alcohol in the past 12 months were categorised as low risk or hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT). Due to the cross sectional nature of the two samples two-tailed two-proportion z-test and two sample t-tests were employed to determine statistical significance between the two time periods for categorical and continuous variables respectively.

Results

At T1 and T2 89.1 % and 87.2 % of the total sample reported drinking alcohol in the past month respectively. Hazardous levels of alcohol consumption reduced slightly between T1 (39.7 %) and T2 (38 %). In both time periods hazardous drinkers reported significantly higher mean scores for experienced harm, second-hand harm and witnessed harm scores compared to low risk drinkers (p <0.001). Hazardous drinkers were significantly more likely to experience academic problems due to their alcohol consumption and to report more positive alcohol expectations than low risk drinkers at both time periods (p <0.001).

Conclusions

Harms and problems for students who report hazardous drinking are of concern and efforts should be made to ensure integrated and targeted strategies reach higher risk students and focus on specific issues such as driving while intoxicated and alcohol related unplanned sexual activity. However there is also a need for universal strategies targeting all students and low risk drinkers as they too are exposed to alcohol harms within the drinking and social environment. Changing the culture of the university environment is a long term aim and to effect change a sustained combination of organisational actions, partnerships and educational actions is required.

A cross sectional evaluation of a total smoking ban at a large Australian university

BACKGROUND

Total smoking bans have been found to contribute positively to the health of non-smokers by reducing exposure to second-hand smoke, and to enhance the likelihood of cessation among smokers.

METHODS

Two cross-sectional electronic surveys of staff and students at a large Australian university were conducted prior (n = 969) and 1 year post (n = 670) the implementation of a smoke free campus policy. Demographics, tobacco use, intention to quit, attitudes towards smoking and smoking restrictions and awareness of and attitudes towards the campus smoking policy were measured.

RESULTS

Exposure to second-hand smoke (SHS) reduced significantly (p < 0.001) one year after policy implementation. Smoking prevalence was similar at both time periods (T1 9.3 %; T2 8.4 %) and over half of smokers indicated they were planning to quit smoking in the future (T1 65.5 vs T2 62.3 %). There was a significant increase in positive responses to the statement the campus should be totally smoke free including all outdoor areas at T2 compared to T1 (T1 60.8 vs T2 71.4 %; p < 0.001), however respondents felt there should be places on campus for smokers to smoke (T1 53.6 vs T2 47 %; p < 0.05).

CONCLUSIONS

This study found a significant positive difference in exposure SHS after implementation of the total ban. Although prevalence of smoking in this study was low, the proportion of respondents who were contemplating smoking cessation suggests support for smokers would be beneficial. Continued awareness raising, education and enforcement is likely to enhance the long term outcomes of the total ban.

A systematic review protocol examining the effect of vitamin D supplementation on endothelial function

INTRODUCTION

Vitamin D has potential benefits for extraskeletal health. These could include an anti-inflammatory effect as well as a reduction in endothelial dysfunction. We aim to provide quality evidence for the hypothesis that supplementation with vitamin D will improve endothelial function (EF), possibly through the abrogation of systemic inflammation.

METHODS AND ANALYSIS

We will conduct a systematic review of all randomised controlled trials on vitamin D supplementation and EF lasting 12 weeks or more. The search will cover the period 2000-2015 and include studies that describe direct measures of EF, markers of endothelial cell (EC) activation and if concurrently reported, indicators of systemic inflammation. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and study quality will be assessed by the Jadad score in addition to an evaluation of allocation concealment and data analysis. If sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score, for both fixed and random effect models. I(2) statistics and Galbraith plots will be used to assess heterogeneity and identify their potential sources. Potential publication and small sample size bias will be assessed by visual inspections of funnel plots and also Egger's test. Meta-regression analysis (if feasible) will be conducted with restricted maximum likelihood (REML) estimation method, controlling for potential confounders (demographics, study methods, location, etc). A backward elimination process will be applied in the regression modelling procedure. Subgroup analysis, conditional on number of studies retrieved and their sample size, will be stratified on participant disease category, total dose administered, degree of 25(OH)D change and type of supplement used.

ETHICS AND DISSEMINATION

Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentation and the popular press.

TRIAL REGISTRATION NUMBER

International Prospective Register for Systematic Reviews (PROSPERO) number CRD42014013523.

Mental health first aid training for nursing students: a protocol for a pragmatic randomised controlled trial in a large university

BACKGROUND

The impact of mental health problems and disorders in Australia is significant. Mental health problems often start early and disproportionately affect young people. Poor adolescent mental health can predict educational achievement at school and educational and occupational attainment in adulthood. Many young people attend higher education and have been found to experience a range of mental health issues. The university setting therefore presents a unique opportunity to trial interventions to reduce the burden of mental health problems. Mental Health First Aid (MHFA) aims to train participants to recognise symptoms of mental health problems and assist an individual who may be experiencing a mental health crisis. Training nursing students in MHFA may increase mental health literacy and decrease stigma in the student population. This paper presents a protocol for a trial to examine the efficacy of the MHFA training for students studying nursing at a large university in Perth, Western Australia.

METHODS/DESIGN

This randomised controlled trial will follow the CONSORT guidelines. Participants will be randomly allocated to the intervention group (receiving a MHFA training course comprising two face to face 6.5 hour sessions run over two days during the intervention period) or a waitlisted control group (not receiving MHFA training during the study). The source population will be undergraduate nursing students at a large university located in Perth, Western Australia. Efficacy of the MHFA training will be assessed by following the intention-to-treat principle and repeated measures analysis.

DISCUSSION

Given the known burden of mental health disorders among student populations, it is important universities consider effective strategies to address mental health issues. Providing MHFA training to students offers the advantage of increasing mental health literacy, among the student population. Further, students trained in MHFA are likely to utilise these skills in the broader community, when they graduate to the workforce. It is anticipated that this trial will demonstrate the scalability of MHFA in the university environment for pre-service nurses and that implementation of MHFA courses, with comprehensive evaluation, could yield positive improvements in the mental health literacy amongst this target group as well as other tertiary student groups.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614000861651 .

Vitamin D supplementation and body weight status: a systematic review and meta-analysis of randomized controlled trials

Vitamin D is anticipated to have many extra-skeletal health benefits. We questioned whether supplementation with the vitamin influenced body weight and composition. A systematic review and meta-analysis was conducted on high-quality, randomized controlled trials (RCTs) that had supplemented vitamin D without imposing any caloric restriction. Eighteen trials reporting either body weight, body mass index (BMI), fat mass (FM), percentage fat mass (%FM) or lean body mass (LBM) met our criteria. Twelve studies provided the required data for the meta-analysis. Vitamin D supplementation did not influence the standardized mean difference (SMD) for body weight, FM, %FM or LBM. A small but non-significant decrease in BMI (SMD = -0.097, 95% confidence interval: [-0.210, 0.016], P = 0.092) was observed. Meta-regression confirmed that neither the absolute vitamin D status achieved nor its change from baseline influenced the SMD of any obesity measure. However, increasing age of the subjects predicted a shift in the SMD for FM towards the placebo treatment, whereas a greater percentage of women in these studies favoured a decrease in FM following vitamin D. Vitamin D supplementation did not decrease measures of adiposity in the absence of caloric restriction. A potential confounding by age and gender was encountered.

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

ISSUE ADDRESSED

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

"Moving forward: a cross sectional baseline study of staff and student attitudes towards a totally smoke free university campus"

Background

Baseline data were collected to inform the adoption, implementation and institutionalisation phases of a completely smoke free campus policy at a large Western Australian university with a diverse student and staff community.

Methods

An online survey was randomly emailed to staff and students to measure the attitudes towards and the acceptability and enforcement of the policy prior to implementation. In total, 969 respondents completed the survey.

Results

General attitudes towards smoking were negative. While smokers, ex-smokers and non-smokers were supportive of smoke free policy on campus, 65.7% of respondents felt the campus should be completely smoke free. Respondents indicated a smoke free policy should be stringently enforced. The majority of respondents reported that they had been exposed to second-hand smoke on campus (n = 768; 79.5%).

Conclusion

Theory of Organisational Change provides a useful framework to support the implementation of the completely smoke free policy in the University setting. The implementation process needs to consider the broad range of issues associated with implementing a completely smoke free policy and address issues such as safety of smokers, ensuring smokers are not marginalised and ensuring a comprehensive program is implemented. These baseline findings can be used to advocate for the implementation of a comprehensive range of strategies that recognise the addictive nature of tobacco smoking and address attitude and behaviour change, environmental adaptations and effective implementation of the policy. Administration should consider smokers and non-smokers when policy is implemented.

Reducing the environmental impact of dietary choice: perspectives from a behavioural and social change approach

Climate change is recognised as a significant public health issue that will impact on food security. One of the major contributors to global warming is the livestock industry, and, relative to plant-based agriculture, meat production has a much higher environmental impact in relation to freshwater use, amount of land required, and waste products generated. Promoting increased consumption of plant-based foods is a recommended strategy to reduce human impact on the environment and is also now recognised as a potential strategy to reduce the high rates of some chronic diseases such as cardiovascular disease and certain cancers. Currently there is a scant evidence base for policies and programs aiming to increase consumption of plant-based diets and little research on the necessary conditions for that change to occur and the processes involved in such a change. This paper reviews some of the environmental and health consequences of current dietary practices, reviews literature on the determinants of consuming a plant-based diet, and provides recommendations for further research in this area.

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

Background

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

Method

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

Results

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

Conclusions

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

Trial registration

ACTRN12608000104358

Ice crystal concentration in cumulus clouds: influence of the drop spectrum

Secondary ice crystals are thrown off when supercooled cloud drops are captured and freeze on a moving target in a cloud at -5 degrees C. The rate of production of these ice crystals is proportional to the rate of accretion of drops of the diameter >/=24 micrometers.

Randomized controlled trial of proactive web-based alcohol screening and brief intervention for university students

BACKGROUND

University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program.

METHODS

A randomized controlled trial was conducted at an Australian university in 2007. Invitations were sent to 13 000 undergraduates (age range, 17-24 years) to complete a Web-based Alcohol Use Disorders Identification Test. Of 7237 students who responded, 2435 scored in the hazardous/harmful range (> or =8) and were randomized, and 2050 (84%) completed at least 1 follow-up assessment. Intervention was 10 minutes of Web-based motivational assessment and personalized feedback. Controls received only screening. Follow-up assessments were conducted at 1 and 6 months with observers and participants blinded to allocation. Outcome measures were drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, prevalence of binge drinking, and prevalence of heavy drinking.

RESULTS

Mean (SD) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 (5.1) and 14.2 (5.1), respectively. After 1 month, participants receiving intervention drank less often (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.83-0.94), smaller quantities per occasion (RR, 0.93; 95% CI, 0.88-0.98), and less alcohol overall (RR, 0.83; 95% CI, 0.78-0.90) than did controls. Differences in alcohol-related harms were nonsignificant. At 6 months, intervention effects persisted for drinking frequency (RR, 0.91; 95% CI, 0.85-0.97) and overall volume (RR, 0.89; 95% CI, 0.82-0.96) but not for other variables.

CONCLUSION

Proactive Web-based screening and intervention reduces drinking in undergraduates, and such a program could be implemented widely.

The cow in the room: public knowledge of the links between dietary choices and health and environmental impacts

ISSUE ADDRESSED

This paper describes results of a survey comparing people's knowledge of health and environmental impacts of dietary choices. Dietary choice is one of the key ways in which individuals can reduce their environmental impact in relation to water use and greenhouse gas emissions but this may not be widely known amongst the public due to limited press coverage.

METHODS

A street intercept survey was conducted asking open ended questions on how people can help the environment, maintain or improve health and basic demographics. The sample size was 107 with a refusal rate of 51%.

RESULTS

Only 3.2% of the sample made a link between dietary choice and environmental impact whereas 85.6% of the sample referred to dietary choice in relation to personal health. Transport options and keeping active were popular responses to both health and environmental categories.

CONCLUSIONS

It seems that very few people are aware that the livestock sector is the second largest contributor to equivalent greenhouse gas emissions and one of the largest users of fresh water. Reduction in red meat consumption could have both important positive health and environmental impacts.

Changing communities, changing spaces: the challenges of health promotion outreach in cyberspace

This article is a case study of an Internet chat room outreach project in Perth, Western Australia. The CyberReach project sought to adapt current peer based health promotion outreach, training and supervision frameworks to an online outreach setting in a way that was effective and supported by the online community. It targeted marginalised groups to trial the provision of online mental and sexual health promotion incorporating a participatory action research model into its development and implementation. Three 6-week trial periods were conducted and significant changes were made in response to changes in the online environment and to improve sustainability and effectiveness of the protocols. Four themes arose from CyberReach's experience: online group processes are unique due to the creation of extensive personal networks and occurrence of disclosure without face-to-face contact across potentially large geographic barriers; flexibility is required to adapt to technological changes and online community flux; enforcing boundaries and delineating peer education from therapeutic support can be challenging when only using text-based communication; and Internet outreach can be time intensive with small returns in actual community engagement and constant technological up-skilling of staff may be required. Based on the project's experiences we offer the following recommendations when planning similar Internet outreach strategies: Funding and planning groups need to be aware that the Internet environment is constantly changing and planning and funding arrangements need to reflect a capacity to remain flexible; Programs need to be firmly connected to the communities they are outreaching therefore a peer-based education component is strongly encouraged; Careful consideration should be taken regarding data collection so that the environment and the individuals within are respected; Further research needs to be conducted to understand the styles and approaches of different online interactions, and the relative influence of technical platforms, gender and age.

Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial

We carried out a randomised, prospective, multicentre clinical trial of the treatment of Colles' fractures. A total of 339 patients was placed into two groups, those with minimally displaced fractures not requiring manipulation (151 patients) and those with displaced fractures which needed manipulation (188 patients). Treatment was by either a conventional Colles' plaster cast (a control group) or with a prefabricated functional brace (the Aberdeen Colles' fracture brace). Similar results were obtained in both groups with regard to the reduction and to pain scores but the brace provided better grip strength in the early stages of treatment. This was statistically significant after five weeks for both manipulated and non-manipulated fractures. At the tenth day the results were statistically significant only in manipulated fractures. There was no significant difference in the functional outcome between the two treatment groups. However, younger patients and those with less initial displacement had better functional results.

Antibodies against human putamen in adolescents with anorexia nervosa

OBJECTIVE

To examine whether antiputamen antibodies are present in adolescents with anorexia nervosa (AN).

METHOD

Using enzyme-linked immunosorbent assay (ELISA) with an extract of human putamen as an antigen, sera samples obtained from 22 adolescents with active AN and from 22 healthy adolescents (control group) were assayed for antibodies to neuronal components

RESULTS

Mean optical density (OD) readings for serum antibodies against human putamen in adolescents with AN was significantly greater than the mean OD readings in the control group (0.492 +/- 0.086 vs. 0.275 +/- 0.028, p =.02). When serum positivity was defined as an OD level greater than 2 SD above the mean control group value (0.541), antiputamen antibodies were detected in the blood of 6 AN patients (27%) whereas they were detected in the blood of 1 patient (5%) in the control group (p <.05; Fisher's exact test).

DISCUSSION

The detection of antiputamen antibodies in adolescents with AN suggests an underlying immune process at the putamen level in some patients with this eating disorder.

Investigation into the tribological condition of acetabular tissue after bipolar joint replacement hip surgery

The aim of this research was to investigate the tribological condition of acetabular tissue before and after bipolar hip surgery. Articular cartilage was taken from the femoral head of patients undergoing primary joint replacement as a control. Tissue was also taken from the acetabular cups of patients undergoing revision hip surgery after primary bipolar surgery and compared with the control cartilage. The biomechanical characteristics of the two tissue types were tested using friction and compression tests. The friction tests were carried out on a sliding friction rig under nominal contact stresses of 0.5 and 4 MPa. The compression tests were carried out under a 0.8 MPa contact stress. The majority of the bipolar patients produced friction coefficients that were significantly higher than those produced by the control group, and the compression tests highlighted that the tissue from the bipolar patients produced a much greater rate of increase in displacement compared with the control cartilage. Histology showed major differences between the control cartilage and the bipolar tissue. The control cartilage showed a healthy collagen structure with a good distribution of proteoglycan whereas the majority of the bipolar tissue had lost tissue architecture and had a sparse fibrous structure. The high friction coefficients with the bipolar tissue imply that the frictional torque at the outer head of the bipolar prosthesis would be large compared with the inner bearing frictional torque. It was therefore predicted that the motion of the bipolar prosthesis should occur at the inner bearing.

Anomalous diffraction theory for arbitrarily oriented finite circular cylinders and comparison with exact T-matrix results

A general method is developed to formulate extinction and absorption efficiency for nonspherical particles at arbitrary and random orientations by use of anomalous diffraction theory (ADT). An ADT for finite circular cylinders is evaluated as an example. Existing ADT's for infinite cylinders at arbitrary orientations and for finite cylinders at the normal incidence are shown to be special cases of the new formulation. ADT solutions for finite cylinders are shown to approach the rigorous T-matrix results when the refractive indices approach unity. The importance of some physical processes that are neglected in the ADT approximation are evaluated by comparisons between ADT and rigorous calculations for different particle geometries. For spheres, van de Hulst's ADT and Mie theory are used, whereas the ADT that we present and T-matrix calculations are used for cylinders of different diameter-to-length ratios. The results show that the differences in extinction between ADT and exact solutions generally decrease with nonsphericity. A similar decrease occurs for absorption at wavelengths of relatively strong absorption. The influence of complex refractive index is evaluated. Our results suggest that ADT may provide a useful approximation in parameterization and remote sensing of cirrus clouds in the Christiansen bands where the real part of the refractive index approaches unity and/or where relative absorption is strong.

Corona-producing ice clouds: a case study of a cold mid-latitude cirrus layer

A high (14.0-km), cold (-71.0 degrees C) cirrus cloud was studied by ground-based polarization lidar and millimeter radar and aircraft probes on the night of 19 April 1994 from the Cloud and Radiation Testbed site in northern Oklahoma. A rare cirrus cloud lunar corona was generated by this 1-2-km-deep cloud, thus providing an opportunity to measure the composition in situ, which had previously been assumed only on the basis of lidar depolarization data and simple diffraction theory for spheres. In this case, corona ring analysis indicated an effective particle diameter of ~22 mum. A variety of in situ data corroborates the approximate ice-particle size derived from the passive retrieval method, especially near the cloud top, where impacted cloud samples show simple solid crystals. The homogeneous freezing of sulfuric acid droplets of stratospheric origin is assumed to be the dominant ice-particle nucleation mode acting in corona-producing cirrus clouds. It is speculated that this process results in a previously unrecognized mode of acid-contaminated ice-particle growth and that such small-particle cold cirrus clouds are potentially a radiatively distinct type of cloud.

Droplet size spectra and water-vapor concentration of laboratory water clouds: inversion of Fourier transform infrared (500-5000 cm(-1)) optical-depth measurement

Infrared extinction optical depth (500-5000 cm(-1)) has been measured with a Fourier transform infrared spectrometer for clouds produced with an ultrasonic nebulizer. Direct measurement of the cloud droplet size spectra agree with size spectra retrieved from inversion of the extinction measurements. Both indicate that the range of droplet sizes is 1-14 mum. The retrieval was accomplished with an iterative algorithm that simultaneously obtains water-vapor concentration. The basis set of droplet extinction functions are computed once by using numerical integration of the Lorenz-Mie theory over narrow size bins, and a measured water-vapor extinction curve was used. Extinction and size spectra are measured and computed for both steady-state and dissipating clouds. It is demonstrated that anomalous diffraction theory produces relatively poor droplet size and synthetic extinction spectra and that extinction measurements are helpful in assessing the validity of various theories. Calculations of cloud liquid-water content from retrieved size distributions agree with a parameterization based on optical-depth measurements at a wave number of 906 cm(-1) for clouds that satisfy the size spectral range assumptions of the parameterization. Significance of droplet and vapor contribution to the total optical depth is used to evaluate the reliability of spectral inversions.