Ethical considerations in investigating youth alcohol norms and behaviours: a case for mature minor consent.

Mature minor consent only became available in Australia in 2007. There is neither an explicitly defined protocol, nor a clear definition evident in the literature relating to use of the mature minor concept in health research. Due to difficulties in defining fixed age ranges to varying levels of maturity and vulnerability, there is a lack of clarity surrounding when it might be reasonable and ethical to apply for or grant a waiver for parental consent. This paper describes the challenges faced and solutions created when gaining approval for use of mature minor consent in a respondent-driven sampling (RDS) study to explore the social norms and alcohol consumption among 14-17-year-old adolescents (n = 1012) in the community. The University's Human Research Ethics Committee granted mature minor consent for this study, and the techniques applied enabled recruitment of adolescents from community-based settings through use of RDS to achieve the required sample. This paper has relevance for research that requires a waiver for parental consent; it presents a case study for assessing mature minors and makes recommendations on how ethical guidelines can be improved to assist human research ethics application processes.

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.

Sustainability of a physical activity and nutrition program for seniors.

OBJECTIVE: This prospective cohort study aimed to determine the impact of a low cost, home-based physical activity and nutrition program for older adults at 6 months follow-up. DESIGN: A follow-up survey was conducted 6 months after program completion via computer-assisted telephone interviewing. The International Physical Activity Questionnaire and the Fat and Fibre Barometer were used to measure physical activity levels and dietary behaviours, respectively. Self-reported height, weight, waist and hip circumferences were obtained. Changes over three time points of data collection (baseline, post-program, follow-up) and differences between the intervention and control groups were assessed. The use of program materials was also evaluated. SETTING: Community and home-based. PARTICIPANTS: Insufficiently active 60 to 70 year olds (n = 176, intervention and n = 198, control) residing in suburbs within the Perth metropolitan area. RESULTS: A sustained improvement was observed for the intervention group in terms of fat avoidance behaviours (p interaction = .007). Significant improvements were found for strength exercises, fibre intake, body mass index and waist-to-hip ratio at either post-program or follow-up, however the overall effect was not significant. At post-program, the intervention group increased time spent participating in moderate activity by 50 minutes (p > .05), which was followed by a significant decline at follow-up (p < .05). Among intervention group participants, males and females differed with respect to strength exercises and moderate physical activity. CONCLUSION: This low-cost physical activity and nutrition intervention resulted in a sustained improvement in fat avoidance behaviours and overall short-term gains in physical activity. Future studies for older adults are recommended to investigate gender-specific behavioural barriers as well as booster interventions which focus on physical activity.

Pre-incision antibiotic prophylaxis reduces the incidence of post-caesarean surgical site infection.

A two-part prospective study was conducted to assess rates of surgical site infection (SSI) following caesarean section in a large Australian regional hospital before and after a change of timing of antibiotic prophylaxis from after cord clamping to pre-incision. SSI rates dropped from 10.8% in 2010 to 2.8% in 2011 with no adverse neonatal consequences, providing further evidence that antibiotic prophylaxis should be given pre-incision for caesarean section in hospitals in Australia and New Zealand, as is now accepted practice elsewhere.

Rheumatic heart disease in pregnancy: cardiac and obstetric outcomes.

BACKGROUND: Rheumatic heart disease (RHD) remains an important health issue for indigenous women of child-bearing age in northern Australia. However, the influence of RHD on maternal outcomes with current clinical practice is unclear. AIMS: To determine maternal cardiac complications and obstetric outcomes in patients with RHD. METHODS: Retrospective case note analysis of women with RHD who received obstetric care between July 1999 and May 2010 at Cairns Base Hospital in north Queensland. Outcome measures were obstetric interventions and outcomes, cardiac interventions and complications, stratified according to a cardiac risk score (CRS). RESULTS: Ninety-five confinements occurred in 54 patients, of whom 52 were Indigenous Australians. There were no maternal or neonatal deaths. With a CRS of 0, cardiac complications occurred in 0 of 70 confinements; with a CRS of 1, complications occurred in 5 of 17 confinements (29%); with a CRS of >1, complications occurred in 2 of 4 confinements (50%). Another four patients were first diagnosed with RHD after developing acute pulmonary oedema during the peripartum period. CONCLUSIONS: RHD has a major impact on maternal cardiac outcomes. However, with current management practices, maternal and fetal mortality are low, and the incidence of complications is predictable based on known risk factors.

Intravenous oxytocin bolus of 2 units is superior to 5 units during elective Caesarean section.

BACKGROUND: The optimal dose of oxytocin at Caesarean section is unclear. Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas an inadequate dose can result in increased uterine bleeding. We compared the effects of two doses of oxytocin in a randomized double-blind trial. METHODS: Eighty patients undergoing elective Caesarean section received an i.v. bolus of either 2 or 5 units (u) of oxytocin after delivery, followed by an oxytocin infusion of 10 u h(-1). All received combined spinal-epidural anaesthesia with arterial pressure maintained by a phenylephrine infusion. We compared changes in heart rate (HR), mean arterial pressure (MAP), blood loss, uterine tone, the need for additional uterotonic drugs, and emetic symptoms. RESULTS: There was a greater increase in mean (sd) HR in patients who received 5 u of oxytocin [32 (17) beats min(-1)] than in those who received 2 u [24 (13) beats min(-1)] (P=0.015). There was a larger decrease in MAP in patients who received 5 u [13 (15) mm Hg] than in those who received 2 u [6 (10) mm Hg] (P=0.030). The frequency of nausea and antiemetic use was higher after 5 u (32.5%) than 2 u (5%) (P=0.003). There were no differences in blood loss, uterine tone, or requests for additional uterotonic drugs (17.5% in both groups). CONCLUSIONS: In elective Caesarean section, a 2 u bolus of oxytocin results in less haemodynamic change than 5 u, with less nausea and no difference in the need for additional uterotonics.

Social capital: implications from an investigation of illegal anabolic steroid networks.

Numerous studies have linked the constructs of social capital with behaviours that are health enhancing. The factors of social trust, social cohesion, sense of belonging, civic involvement, volunteer activity, social engagement and social reciprocity are all associated with social capital and their existence is often linked with communities or settings where health enhancement is high. Utilizing an interpretive perspective, this paper demonstrates how the existence of social capital may enhance the transition into drug use, the experience of using an illegal drug and decrease the risk of detection. It highlights how social capital may contribute to behaviours which are not health enhancing. Using a variety of data, including participant observation of 147 male anabolic steroid users and 98 semi-structured in-depth interviews with male anabolic steroid users, dealers and distributors it was found that social capital facilitated the operation of the illegal anabolic steroid distribution network. The subcultural norms and social trust that existed within the network allowed anabolic steroid dealers to sell the drug to others with reduced risk of detection. It is argued that social capital facilitates the distribution of illegal anabolic steroids and that social capital is a non-discriminatory concept, that may enhance both negative and positive health-related behaviours.

Introductory postcards: do they increase response rate in a telephone survey of older persons?

The purpose of this study was to assess whether contact by mail via an introductory postcard would increase the response rate to a telephone survey in a selected population of 348 people 60 years and older. Of this group, 208 were sent a postcard introducing the study and informing them that someone would call in the next 1-2 weeks to conduct a telephone interview. The remaining sample of 140 did not receive the introductory postcard. Amongst the potential participants who were contacted and able to participate (n = 240), the response rate for completed interview was 58.0% for those sent a postcard and 42.3% for those who were not. The refusal rate was 25.3% (postcard sent) and 37.2% (not sent a postcard). When the outcome of contact is collapsed to two categories, 'agreed to participate' and 'refusal', the response rate to participate was 73.5% (sent a postcard) and 59.0% (not sent a postcard) (chi(2) 5.14, d.f. 1, sign. 0.023). The response rate amongst those who recall being sent a postcard rose to 86.0%. Whether agreeing to participate or refusing to be involved in the survey was dependent on being sent an introductory postcard. The conclusion is that mailing a postcard prior to the first telephone contact increases the participation rates of older persons in a telephone survey at very little extra cost (A$0.60 per person).

Training patterns and sports injuries in triathletes.

Sports-related injuries are a significant health problem within Australia, and constitute a national health priority. There is limited Australian research data available on factors that contribute to triathlon injuries, and in particular on how training patterns relate to injury risk. This study examined the association between training patterns and injury in mostly non-elite triathletes. A cross-sectional survey of 258 triathletes completed a questionnaire that focused on injuries they had sustained during the previous three triathlon seasons. Statistical associations were found between hours of training and sustaining an injury. These associations were U shaped, with those triathletes training at low levels and at high levels more likely to sustain an injury. The results suggest that, for non-elite triathletes, the likelihood of sustaining an injury is least when training for a total of 8 to 10 hrs per week, specifically cycling for five to six hrs and running for three to four hrs weekly. Time spent on swimming training does not appear to affect injury risk. This research is seen as a contribution towards assisting triathletes in the planning of training programs aimed at reducing the risk of injury.

Community participation in road safety: barriers and enablers.

The objectives of the paper were to identify barriers to community participation in road safety activities and to recommend strategies to reduce those barriers. Information was obtained from: a review of relevant literature, from the authors' extensive community-based experiences, from undertaking community-based research, and from interviews with key stakeholders in road safety in Western Australia. Ten significant barriers to community participation were identified. These are classified into two groups: personnel and planning issues. The former includes: reasons why people are often reluctant to become involved in projects in their communities, a lack of leadership, and a lack of skills. The latter includes: inappropriate program foci, inappropriate program evaluation, lack of resources, and a lack of sustainability. It was concluded that the barriers to community involvement in road safety initiatives are similar in many parts of Australia and overseas and apply to a wide range of health promotion interventions besides road safety. Awareness of the barriers and knowledge of their solutions can ensure that appropriate steps are taken to maximise the likelihood of community participation.

A decision-making model for health promotion advocacy: the case for advocacy of drunk driving control measures.

This paper presents a decision-making model which can help public health professionals justify their decision to advocate for a particular intervention. The model is demonstrated by a case study related to advocacy of Random Breath Testing (RBT). For the purpose of this paper advocacy is a "catch-all word for the set of skills used to create a shift in public opinion and mobilise the necessary resources and forces to support an issue, policy, or constituency..." (Wallack, Dorfman, Jernigan & Themba, 1994).

Child pedestrian injury prevention project: student results.

BACKGROUND: Few comprehensive pedestrian safety interventions for primary-school-age children have been developed and evaluated. This paper reports the impact of the 3-year (1995-1997) Child Pedestrian In jury Prevention Project (CPIPP) on a cohort of 1603 children followed from age 6 to 9 years. This multicomponent project comprised an educational intervention for students, their parents and teachers, and the local community, as well as several environmental interventions. The primary aim of CPIPP was to improve children's road-related behavior and to enhance the safety of their road environment. METHODS: Three communities were assigned to the treatment conditions: (1) high-education, community, and environmental interventions; (2) moderate-education intervention only; and (3) comparison (usual road safety education). Children's pedestrian knowledge and road crossing and playing behaviors were assessed using a pre- and posttest self-report questionnaire. Their self-reported road crossing behaviors were validated using an observational schedule and brief interview. RESULTS: Children in the high and moderate intervention groups were significantly more likely to cross the road with adult supervision (P = 0.013) and play away from the road (P = 0.000) than the comparison group. No differences were detected in children's pedestrian safety knowledge between the intervention and comparison groups. CONCLUSIONS: While several methodological limitations may have influenced the study outcomes, these data nonetheless indicate that in the study sample the CPIPP educational intervention deaccelerated the natural increase in children's pedestrian-related risk behavior.

Measuring community/environmental interventions: the Child Pedestrian Injury Prevention Project.

OBJECTIVES: To assess the effectiveness of community/environmental interventions undertaken as part of the Child Pedestrian Injury Prevention Project (CPIPP). SETTING: Three communities (local government areas) in the Perth metropolitan area, Western Australia. METHODS: A quasiexperimental community intervention trial was undertaken over three years (1995-97). Three communities were assigned to either: a community/environmental road safety intervention and a school based road/pedestrian safety education program (intervention group 1); a school based road/pedestrian safety education program only (intervention group 2); or to no road safety intervention (comparison group). Quantification of the various road safety community/environmental activities undertaken in each community during the trial was measured, and a cumulative community activity index developed. Estimates of the volume and speed of vehicular traffic were monitored over a two year period. RESULTS: Greater road safety activity was observed in intervention group 1 compared with the other groups. A significant reduction in the volume of traffic on local access roads was also observed over the period of the trial in intervention group 1, but not in the remaining groups. CONCLUSIONS: The findings indicate that the various community/environmental interventions initiated in collaboration with CPIPP in intervention group 1 contributed, in part, to the observed reduction in the volume of traffic. A combination of community/environmental interventions and education are likely to reduce the rate of childhood pedestrian injury.