Evaluation of a Health Promoting Schools program to reduce smoking in Australian secondary schools.

This randomized controlled trial evaluated the effectiveness of a multicomponent Health Promoting Schools (HPS) intervention program in improving self-reported smoking outcomes among a cohort of adolescents in 22 public secondary schools in the Hunter Region of New South Wales, Australia. Pre-test surveys were completed by students in the first 2 years of secondary school, with a 2-year post-test survey. Multivariate analyses examined intervention effect for the main outcome, post-test smoking behavior, controlling for pre-test smoking status, school and other confounders. The sample comprised the cohort of 1852 students who completed both surveys. The results demonstrated that the HPS program failed to improve smoking behavior over the 2 years (equal increase of 10% in both groups). The program was successful in improving smoking knowledge, but not attitudes, in intervention versus control group (P < 0.001). Independent predictors of post-test smoking included: pre-test smoking [odds ratio (OR) = 5.44; 95% confidence interval (CI) = 3.20-9.28], being female (OR = 0.55; CI = 0.35-0.87), having more close friends who smoked (OR = 1.42; CI = 1.33-1.52), peer group having no clear opinion about smoking (OR = 3.23; CI = 1.27-8.27), having more positive and less negative attitudes towards smoking, and being less involved in school activities. We discuss methodological issues in multicomponent community-based interventions, and highlight the strengths and limitations of this study.

The Phe-X-Glu DNA binding motif of MutS. The role of hydrogen bonding in mismatch recognition.

The crystal structures of MutS protein from Thermus aquaticus and Escherichia coli in a complex with a mismatch-containing DNA duplex reveal that the Glu residue in a conserved Phe-X-Glu motif participates in a hydrogen-bonded contact with either an unpaired thymidine or the thymidine of a G-T base-base mismatch. Here, the role of hydrogen bonding in mismatch recognition by MutS is assessed. The relative affinities of MutS for DNA duplexes containing nonpolar shape mimics of A and T, 4-methylbenzimidazole (Z), and difluorotoluene (F), respectively, that lack hydrogen bonding donors and acceptors, are determined in gel mobility shift assays. The results provide support for an induced fit mode of mismatch binding in which duplexes destabilized by mismatches are preferred substrates for kinking by MutS. Hydrogen bonding between the O epsilon 2 group of Glu and the mismatched base contributes only marginally to mismatch recognition and is significantly less important than the aromatic ring stack with the conserved Phe residue. A MutS protein in which Ala is substituted for Glu(38) is shown to be defective for mismatch repair in vivo. DNA binding studies reveal a novel role for the conserved Glu residue in the establishment of mismatch discrimination by MutS.

Interaction of Escherichia coli MutS and MutL at a DNA mismatch.

MutS and MutL are both required to activate downstream events in DNA mismatch repair. We examined the rate of dissociation of MutS from a mismatch using linear heteroduplex DNAs or heteroduplexes blocked at one or both ends by four-way DNA junctions in the presence and absence of MutL. In the presence of ATP, dissociation of MutS from linear heteroduplexes or heteroduplexes blocked at only one end occurs within 15 s. When both duplex ends are blocked, MutS remains associated with the DNA in complexes with half-lives of 30 min. DNase I footprinting of MutS complexes is consistent with migration of MutS throughout the DNA duplex region. When MutL is present, it associates with MutS and prevents ATP-dependent migration away from the mismatch in a manner that is dependent on the length of the heteroduplex. The rate and extent of mismatch-provoked cleavage at hemimethylated GATC sites by MutH in the presence of MutS, MutL, and ATP are the same whether the mismatch and GATC sites are in cis or in trans. These results suggest that a MutS-MutL complex in the vicinity of a mismatch is involved in activating MutH.

Requirement for Phe36 for DNA binding and mismatch repair by Escherichia coli MutS protein.

The MutS family of DNA repair proteins recognizes base pair mismatches and insertion/deletion mismatches and targets them for repair in a strand-specific manner. Photocrosslinking and mutational studies previously identified a highly conserved Phe residue at the N-terminus of Thermus aquaticus MutS protein that is critical for mismatch recognition in vitro. Here, a mutant Escherichia coli MutS protein harboring a substitution of Ala for the corresponding Phe36 residue is assessed for proficiency in mismatch repair in vivo and DNA binding and ATP hydrolysis in vitro. The F36A protein is unable to restore mismatch repair proficiency to a mutS strain as judged by mutation to rifampicin or reversion of a specific point mutation in lacZ. The F36A protein is also severely deficient for binding to heteroduplexes containing an unpaired thymidine or a G:T mismatch although its intrinsic ATPase activity and subunit oligomerization are very similar to that of the wild-type MutS protein. Thus, the F36A mutation appears to confer a defect specific for recognition of insertion/deletion and base pair mismatches.

Cigarette smoking, menstrual symptoms and miscarriage among young women.

OBJECTIVE: To examine associations between cigarette smoking and menstrual symptoms and miscarriage among young women. METHOD: The study sample consists of 14,779 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self reported menstrual symptoms and miscarriages. RESULTS: Current smokers and ex-smokers had an increased risk of menstrual symptoms and miscarriages compared with women who had never smoked, with the highest risk occurring in heavy smokers (adjusted odds ratios for those smoking > or = 20 cigarettes per day: premenstrual tension 1.5 (95% confidence interval 1.3 to 1.7), irregular periods 1.5 (1.3 to 1.8), heavy periods 1.6 (1.4 to 1.9), severe period pain 1.5 (1.4 to 1.7), one or more miscarriages 2.0 (1.5 to 2.8). The odds ratios generally increased with numbers of cigarettes smoked and a younger age of starting to smoke. CONCLUSION: This study suggests that young women who smoke are at higher risk of a range of menstrual problems and miscarriage than those who have never smoked. The immediacy of this risk (in contrast to the longer term risks of chronic disease) can be used to improve the relevance of anti-smoking campaigns targeted to young women.

Sexually transmitted infections and use of sexual health services among young Australian women: women's health Australia study.

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors. The study sample comprised 14,762 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics. The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score. This study reports interesting correlates of having an STI among young Australian women aged 18-23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood.

Yeast resolving enzyme CCE1 makes sequential cleavages in DNA junctions within the lifetime of the complex.

CCE1 is a DNA junction-resolving enzyme of Saccharomyces cerevisiae. Such enzymes are required to make two symmetrically paired cleavages in order to resolve the four-way junction productively. Using a cruciform assay, we show here that CCE1 introduces two unilateral cleavages in a sequential manner. This requires that the protein remains bound to the junction, preventing branch migration of the point of strand exchange. From a detailed kinetic analysis, we find that the CCE1 cleavage at a given site is accelerated by a factor of 5-10 when it occurs subsequently to the initial cleavage. These properties ensure a productive resolution of the four-way junction and may be general for junction-resolving enzymes.

Sequence and functional-group specificity for cleavage of DNA junctions by RuvC of Escherichia coli.

RuvC is the DNA junction-resolving enzyme of Escherichia coli. While the enzyme binds to DNA junctions independently of base sequence, it exhibits considerable sequence selectivity for the phosphodiester cleavage reaction. We have analyzed the sequence specificity using a panel of DNA junctions, measuring the rate of cleavage of each under single-turnover conditions. We have found that the optimal sequence for cleavage can be described by (A approximately T)TT downward arrow(C>G approximately A), where downward arrow denotes the position of backbone scission. Cleavage is fastest when the cleaved phosphodiester linkage is located at the point of strand exchange. However, cleavage is possible one nucleotide 3' of this position when directed by the sequence, with a rate that is 1 order of magnitude slower than the optimal. The maximum sequence discrimination occurs at the central TT in the tetranucleotide site, where any alteration of sequence results in a rate reduction of at least 100-fold and cleavage is undetectable for some changes. However, certain sequences in the outer nucleotides are strongly inhibitory to cleavage. Introduction of base analogues around the cleavage site reveals a number of important functional groups and suggests that major-groove contacts in the center of the tetranucleotide are important for the cleavage process. Since RuvC binds to all the variant junctions with very similar affinity, any contacts affecting the rate of cleavage must be primarily important in the transition state. Introduction of the optimal cleavage sequence into a three-way DNA junction led to relatively efficient cleavage by RuvC, at a rate only 3-fold slower than the optimal four-way junction. This is consistent with a protein-induced alteration in the conformation of the DNA.

Lessons learned from the Hunter Region Health Promoting Schools Project in New South Wales, Australia.

This paper describes development, over a five-year period, of the Hunter Region Health Promoting Schools Project in New South Wales (NSW), Australia. The project implemented the principles and philosophy of the Health Promoting Schools concept and evaluated its effectiveness using a randomized controlled trial involving 22 public secondary schools. An overview of the preliminary intervention model based on the health promoting schools philosophy and trialed in a pilot study is provided. The authors also outline barriers to, and difficulties in, implementing the philosophically based intervention model in the secondary school setting. The current intervention approach, which evolved over five years, is described in relation to the roles played by project team members and school communities. In addition, the authors outline guiding principles arising from the new approach which facilitated adoption of health promotion strategies in secondary school settings.

Is there consensus between breast cancer patients and providers on guidelines for breaking bad news?

Eighty-four breast cancer patients, 64 oncologists, and 140 oncology nurses rated the importance of 15 general principles and 12 recommended steps to guide clinicians in breaking bad news to patients. At least 70% of the three samples rated 7 of the 15 principles and 6 of the 12 steps as essential. All three groups agreed that patients have a legal and moral right to accurate and reliable information and that patients should be given the diagnosis and prognosis honestly and in simple language, though not bluntly. The groups differed on the relative importance of other items, with less variation about the steps than about the principles. Patients' perceptions of the importance of various guideline steps and principles are probably most important, given that patients receive the troubling news and that research indicates that how the news is delivered is associated with important patient outcomes. Recommendations for further research are discussed.

Dissection of the sequence specificity of the Holliday junction endonuclease CCE1.

CCE1 is a Holliday (four-way DNA) junction-specific endonuclease which resolves mitochondrial DNA recombination intermediates in Saccharomycescerevisiae. The junction-resolving enzymes are a diverse class, widely distributed in nature from viruses to higher eukaryotes. In common with most other junction-resolving enzymes, the cleavage activity of CCE1 is nucleotide sequence-dependent. We have undertaken a systematic study of the sequence specificity of CCE1, using a single-turnover kinetic assay and a panel of synthetic four-way DNA junction substrates. A tetranucleotide consensus cleavage sequence 5'-ACT downward arrowA has been identified, with specificity residing mainly at the central CT dinucleotide. Equilibrium constants for CCE1 binding to four-way junctions are unaffected by sequence variations, suggesting that substrate discrimination occurs predominantly in the transition state complex. CCE1 cuts most efficiently at the junction center, but can also cleave the DNA backbone at positions one nucleotide 3' or 5' of the point of strand exchange, suggesting a significant degree of conformational flexibility in the CCE1:junction complex. Introduction of base analogues at single sites in four-way junctions has allowed investigation of the sequence specificity of CCE1 in finer detail. In particular, the N7 moiety of the guanine base-pairing with the cytosine of the consensus sequence appears to be crucial for catalysis. The functional significance of sequence specificity in junction-resolving enzymes is discussed.

Norms for the physical and mental health component summary scores of the SF-36 for young, middle-aged and older Australian women.

The SF-36 was developed in the USA to provide an eight-scale health profile and two component summary scores representing physical and mental health. The published norms and scoring procedures are based on data from the US general population. The Australian Longitudinal Study on Women's Health (Women's Health Australia) undertook a survey in 1996 of approximately 42,000 Australian women in three age groups of 18-22, 45-49 and 70-74 years and provided age- and gender-specific norms for the SF-36 health profile. From these data, factor weights and factor score coefficients were calculated for these age- and gender-specific populations of Australian women. Thus, component summary scores for physical and mental health can now be calculated using a formula standardized to the relevant Australian population. This will facilitate the interpretation of the physical and mental health component summary scores in the Australian context and will allow meaningful comparisons within the young, middle-aged and older cohorts of Australian women in the Australian Longitudinal Study on Women's Health.

Validity of the SF-12 Compared with the SF-36 Health Survey in Pilot Studies of the Australian Longitudinal Study on Women's Health.

This study assessed the relative validity of the Medical Outcomes Study Short-Form General Health Survey (SF-36 and SF-12) for Australian women and compared norms for the independently administered and embedded SF- 12. Two samples of women in New South Wales were randomly selected from the Medicare database ( N = 3600). The sample was stratified into young (18 to 22 years), middle-aged (45 to 49 years) and older (70 to 74 years) women, and into women living in urban (40 percent), rural (30 percent) and remote (30 percent) areas. In study 3500 households were selected by random digit dial. The method was a mailout survey. SF-36 scale scores were similar to US norms. For the older group, health profiles of the independent and embedded SF- 12 differed. For the SF-36 and independently administered SF- 12, means differed in all three age groups. The SF-12 physical health scores discriminated between women with poor versus good physical health, and mental health scores discriminated between groups who were or were not psychologically distressed on GHQ-12. The SF- 36, relative to the SF-12, appears to be a more reliable measure for examining changes in health status over time and between groups.

SF-36 Health Profiles of Recently Discharged Hospital Patients in Australia.

This study investigated the characteristics and validity of the SF-36 (Australian version) health profile and summary scores for recently discharged hospital patients and compared this with US and Australian community samples with minor and serious medical conditions. Adult medical, surgical, obstetric and gynaecological patients from a large teaching hospital in NSW, Australia, completed a postal survey 1 week after discharge. The SF- 36 discriminated well among patient groups and performed well on most validity tests. Scale and summary scores varied by age, gender, seriousness of condition on admission, prior health status and hospital group. The findings highlight the potential of the SF-36 in monitoring the health status of Australian hospital patients and assessing the health-related support needed on discharge.

Patterns and correlates of hormone replacement therapy use among middle-aged Australian women.

In this study, we examine the patterns of use of hormone replacement therapy (HRT) among women age 51 to 60 years and describe the characteristics of women who currently use HRT, previously used HRT, and have never used HRT. A brief postal survey of 800 women in this age range was used to determine HRT status. Telephone interviews were then conducted with 258 women (111 currently using HRT, 47 who previously used HRT, and 100 who had never used HRT) to determine characteristics of women who currently or previously used HRT or never used HRT, type of HRT used, duration of use, and reasons for use and nonuse. Nearly 40% of women were currently using HRT, 14% had previously used HRT, and 47% had never used HRT. Women currently using HRT were more likely than those not using HRT to have had a hysterectomy, attribute a greater number of symptoms to the climacteric, be in paid employment, and report a greater number of visits to the doctor over the past 12 months. HRT use among Australian women in their 50s is high and rising. Hysterectomy status, the attribution of symptoms to menopause, paid employment, and health care use were the most important correlates of HRT use. Few women specified long-term prevention of osteoporosis or heart disease as a reason for taking HRT.

'It would be good to know you're not alone': the health care needs of women with menstrual symptoms.

OBJECTIVES: We aimed to explore how menstrual symptoms affect women, women's health care needs, and their expectations and experiences when seeking care; to identify ways to assist women in having their needs met. METHODS: Qualitative research using focus group methodology was carried out. Identification of women experiencing menstrual symptoms through a random community survey of 200 women aged 30-50 years in the Hunter region of New South Wales. Focus group discussions were recorded and transcripts were analysed. RESULTS: All women attending focus groups had sought medical advice for their menstrual problems. Having one doctor with whom they felt comfortable was important. Women expressed difficulties asking questions and were concerned that symptoms may not be taken seriously or may be dismissed as psychological. There was widespread acceptance of alternative 'natural' therapies. CONCLUSIONS: Interactions between doctors (particularly GPs) and women with menstrual symptoms are central to how women perceive the care they receive. There is a need for doctors to demonstrate empathy. For many women, what they needed most from their doctors was to be understood and 'to know they weren't alone'.

Patient-provider agreement on guidelines for preparation for breast cancer treatment.

Guidelines for preparing cancer patients for threatening medical procedures were developed and refined and their perceived relevance and importance rated by three concerned groups--84 breast cancer patients, 64 doctors, and 140 nurses and nurse oncologists. All three groups indicated strong support for the guidelines. Patients and nurses rated more of the guidelines as essential aspects of good quality care than did doctors. Items in which a significant discrepancy existed included the importance of (a) consistent information, (b) involvement of others in preparation, and (c) assistance to the patient in coping with treatment for breast cancer. Doctors, compared with patients and nurses, underrated the importance of some aspects of preparation. These issues should be given more prominence in undergraduate and specialist medical training, as well as in continuing medical education.

Interventions with retailers to reduce cigarette sales to minors: a randomised controlled trial.

We aimed to determine the relative effectiveness of an education intervention and a threat-of-enforcement intervention in reducing sales of cigarettes to under-age youth by randomly allocating 300 retailers in a nonmetropolitan region of New South Wales to: a control group with no intervention; a minimal-intervention group, which received an educational letter; and a maximal-intervention group, which received a threat of enforcement followed by a visit from a public health officer. Retailers were checked for compliance at pretest and post-test, six months apart, by twelve 18-year-olds who were judged by independent raters to look younger. The retailers were surveyed by telephone at both times for knowledge, attitudes and self-reported sales practices. Neither intervention achieved significant improvements for the two key behavioural outcomes: requiring proof of age and display of a warning sign. Neither was there an intervention effect on knowledge about the law. The greatest improvement in the proportion of retailers who believed that the legal age should be 18 or over was in the minimal-intervention group, and both intervention groups were less likely than the control group at post-test to think that it was acceptable to sell to a person who was nearly 18. There was poor overall compliance with the revised legislation at pre-test. The finding of a pretest-to-post-test improvement but no differential intervention effect highlights the methodological difficulties of such research. The interventions may, however, have been partly successful in modifying the attitudes of retailers.

Effectiveness of two strategies for dissemination of sun-protection policy in New South Wales primary and secondary schools.

With rising rates of skin cancer in Australia, there is a need to examine strategies to reduce sun exposure among children. This study aimed to determine the effectiveness of a multifaceted dissemination strategy compared with a simple mail-out strategy in promoting the adoption of comprehensive SunSmart skin protection policies and practices in primary and secondary schools in New South Wales. It also aimed to examine characteristics of the primary and secondary schools that adopted a comprehensive SunSmart policy before and after the intervention. Four hundred randomly selected primary schools and all 381 high schools in New South Wales were randomised to one of two intervention groups. Pretest and post-test surveys of principals were undertaken in 1991 and 1992. Intervention 1 was a simple mail-out of a sample sun-protection policy kit. Intervention 2 comprised the mail-out of the policy kit and a follow-up mail-out of a staff development module. There was a strong intervention effect on adoption of a comprehensive sun-protection policy in primary schools (21 per cent for the 'mail' group compared with 44 per cent for 'mail and staff support' group) but not in high schools (6 per cent and 11 per cent). There was little relationship between adoption of a comprehensive sun-protection policy and sun-protection practices in primary or secondary schools. Further research is needed to determine the most effective ways of ensuring that adoption of a comprehensive sun-protection policy results in effective implementation of sun-protection practices in schools.