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.

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.

Sweat nitrogen losses by and nitrogen balance of preadolescent girls consuming three levels of dietary protein.

A nitrogen balance study was undertaken to determine the effects of three levels of nitrogen intake on the loss of nitrogen through sweat and to assess the impact of sweat nitrogen on the protein needs of preadolescent girls. Values were determined through the collection of 24-hour, total body sweat samples from 15 healthy girls with a mean age of 8 years, 7 months. Mean height and weight of the subjects were 132 cm and 28.9 kg, respectively. Mean sweat nitrogen losses, collected under uncontrolled environmental conditions, were 201 mg, 263 mg and 319 mg/day on 34 g, 57 g and 88 g of protein intake. The environmental conditions throughout the study remained fairly constant. Mean nitrogen balances per day were 0.04 g, 0.55 g and 1.42 g on the respective levels of nitrogen intake, with the inclusion of sweat nitrogen loss, however, a negative nitrogen balance per day was found in 8 and 2 subjects on 34 g and 57 g protein intake. After considering nitrogen retention of 0.3 g which has been recommended by NRC for the minimum nitrogen allowance for growth of preadolescent children, protein intakes higher than that recommended by the NRC-RDA for preadolescent girls may be required for support of normal growth.

Alcohol and the cognitive aspects of choice reaction time.

In a repeated-measures experiment 18 men and 8 women were given ethanol which raised their mean blood alcohol concentration (BAC) to 0, 21, 50 and 73 mg/100 ml. Using the ERM apparatus (Schuhfried Instruments, Austria), which measures choice reaction time to a task with high cognitive content, it was found that both decision and reaction time increased as a function of rising BAC, and that movement time was not affected.

The effectiveness of a dental/dietitian team in the assessment of bulimic dental health.

Individuals with bulimia nervosa have been found to experience a variety of dental complications. Because of purging behaviors and erratic food consumption, the oral manifestations of bulimia frequently include irreversible enamel erosion, xerostomia, and oral mucosal irritation. A pilot study was conducted to determine the effectiveness of the dental/dietitian team in assessing the dental health of individuals with bulimia. Control and bulimic subjects were compared. The results demonstrated a significantly different (p less than .05) intake of folacin-412 micrograms in controls compared with 207 micrograms in bulimic subjects. Control subjects were found to have significantly greater (p less than .05) amounts of calculus deposits on teeth; however, subjects with bulimia demonstrated a lower (p less than .05) saliva pH. We conclude that the collaborative effort of the dental/dietitian team was useful in the assessment of dental health. The team approach may also help to identify clients with bulimia and facilitate therapy.

The effect of bulimia upon diet, body fat, bone density, and blood components.

A study was conducted to determine baseline data for dietary intake, percent body fat, bone mineral density, and blood components in women with bulimia. Eight bulimic and 10 control subjects completed the study. Each subject was assessed for a 3-day diet, frequency of purge, menstrual history, percent body fat, bone mineral density, by dual photon absorptiometry, and blood components. Mean age, height, and weight of subjects were similar. Percent body fat was similar for both groups. Vomiting was the predominant method of purge. Folacin intake was found to be significantly (p less than .05) lower in bulimic subjects. Control subjects consumed greater quantities of vitamin/mineral supplements than the bulimic subjects. Bone mineral density (gm/cm2) was found to be lower in bulimic subjects. Mean hemoglobin (gm/L [gm/dL]) levels were found to be significantly (p less than .01) higher in control subject. The data indicate that the method and duration of purge behavior could influence bone mineral density and blood components.

Validity and reliability of reported dietary intake data.

OBJECTIVE: To compare two training techniques for validity and reliability of dietary instruments and the measurement of total energy expenditure (TEE) to determine whether technique could influence the accuracy of food portion estimates. DESIGN: Adult women were randomized into a control group and an experimental group for comparison of training technique. SETTING: University and research center. SUBJECTS: Five hundred women were screened using the Three-Factor Eating Questionnaire to identify restrained eaters or disinhibitors. Other criteria for selection included good health; absence of thyroid, respiratory, or other diseases; normal menstrual cycles; between the ages of 18 and 50 years. Forty-nine were recruited, with an attrition rate of 10% for a total sample of 44 subjects. INTERVENTION: The control group (n = 26) was trained with food models and the experimental group (n = 18) was trained with a combination of food models and life-sized food photographs. All subjects completed two 24-hour recalls and 14 consecutive days of food records. TEE was measured by the doubly-labeled water method. MAIN OUTCOME MEASURES: Training would improve the accuracy of food portion estimates. STATISTICAL ANALYSES PERFORMED: Analysis of variance, the paired t test, Pearson's correlation coefficient, and Wilcoxon's ranking test. RESULTS: The mean reported intake between instruments was found to be reliable; however, the comparison with TEE was underreported by 21.4% and was thus nonvalid. Training technique made no difference in validity or reliability. Both training techniques improved the accuracy of food portion estimates; however, improvement was enhanced with food photographs. APPLICATIONS/CONCLUSION: The findings indicate that training can improve food portion estimates, and dietary instruments may provide reliable but nonvalid results.

Alcohol and driving: is the 0.05% blood alcohol concentration limit justified?

This paper reviews the findings of experimental and laboratory research to determine whether there is sufficient evidence to support a uniform 0.05% blood alcohol concentration (BAC) as the legal limit for driving. Statistically significant and meaningful decrements in driving-related performance were identified at 0.05% BAC or below in many studies. Younger and inexperienced drinkers and drivers appear to be at greatest risk for alcohol-related traffic crashes. It is concluded that on scientific grounds, there is support for setting the legal limit at 0.05%. The setting of a uniform 0.05% BAC statutory limit should be but one effort within a comprehensive approach including other legal, social, behavioural and environmental strategies to deal with the drink driving problem.

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.

Alcohol consumption patterns of women in Perth, Western Australia.

A survey of women aged 18-64 living in Perth in February 1987 showed that a prospective alcohol consumption diary measured a higher level of consumption (9.3%) than did a retrospective alcohol consumption diary. According to the National Health and Medical Research Council (NH&MRC) guidelines for safe and responsible drinking, 11.2% of women drank alcohol at hazardous levels (14+ drinks per week). Although on an overall weekly basis there was no significant association between age and consumption level, drinking patterns varied on a daily basis according to age. The current study may provide a conservative estimate of the percentage of women at risk. The reasons for this underestimation and the implications are discussed, together with the need to develop health promotion messages based on drinking patterns.

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).

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.