Empowering students to respond to alcohol advertisements: results from a pilot study of an Australian media literacy intervention

Objective : Alcohol media literacy programs in the United States have increased students' media literacy skills and lowered pre‐drinking behaviour. In Australia, no such programs have yet been implemented or evaluated. This pilot study aimed to examine the feasibility and potential impact of an alcohol media literacy program for Australian upper‐primary school children. Methods : Thirty‐seven Year 5 and 6 students (aged 10–12) from one school in the Sydney region participated in 10 one‐hour media lessons. Teacher interviews, student exit slips, teacher observations and a researcher reflective journal were analysed to examine the implementation process, while a pre‐ and post‐questionnaire was analysed to measure outcome. Results : Key factors in implementation were the importance of school context; attainment of English and PDHPE learning outcomes to differing extents; program's useability provided flexibility; perceived complexity and achievability of the lessons and program's engagement and relevance for the students. The program significantly increased media literacy skills and understanding of persuasive intent; decreased interest in alcohol branded merchandise; and lowered perception of drinking norms. Conclusion and implications : An Australian alcohol media literacy program for upper‐primary school children appears feasible, and has potential to lead to measurable outcomes.     

The Neurological Exercise Training (NExT) program: A pilot study of a community exercise program for survivors of stroke

BackgroundMany survivors of stroke face chronic disability and increased risk for recurrent stroke. Regular physical activity can reduce these risk factors and improve cardiovascular fitness. Most survivors of stroke face barriers to exercise, including lack of access to programs; as a result, most are sedentary.ObjectivePilot the Neurological Exercise Training (NExT) program or survivors of stroke for attendance, safety, and effectiveness.MethodsThe NExT program was designed to promote self-directed exercise in a safe, accessible environment. Six participants attended as desired during open gym hours over two exercise periods per week totalling 19 weeks. After, participants were encouraged to continue exercise away from the gym for 20 weeks. Practicability of the program was assessed through safety, attendance, exercise intensity, and perception of the program. Pilot effectiveness measures were performed at five time points and effect sizes were generated.ResultsAttendance averaged 76% (SD12%) of possible sessions with an average duration of 62 (SD 11.3) minutes. Effectiveness measures had positive effect sizes after 19 weeks of the NExT program, but these benefits were lost after 20-weeks (cohen's d, mobility = 0.67 to ?0.22, balance = 0.57 to ?1.22, strength = 0.41 to ?0.30, endurance = 0.09 to ?0.19 and fatigue = 1.02 to ?0.57).ConclusionResults demonstrate that a community-based gym that is accessible for survivors of stroke will be well attended and perceived as beneficial. Pilot data suggests positive changes in multiple health domains regardless of the type of exercise self-selected by participants. Offering the gym on a continual basis may maintain gains.     

Effects of a short teacher training programme on the management of children's sexual behaviours: a pilot study

This small-scale quasi-experimental study set out to examine the effects of a brief training programme aiming to develop primary school teachers' knowledge, attitudes and confidence in recognising and responding to children who display sexual behaviours. Data on prevalence of sexual behaviours observed by teachers in the study, their level of concern and their response strategies were also examined. There were overall improvements in 16 of the 23 self-report questionnaire items after the training session, 6 of which, in comparison to a control group, were sustained at the three-week follow-up. These results suggest that short training courses can be a viable option in improving primary teachers' knowledge and confidence in dealing with children's sexual behaviours within the school setting. These significant findings are discussed in relation to implications for policy and practice as well as future research.     

Encouraging fruit consumption in primary schoolchildren: a pilot study in North Wales, UK

OBJECTIVE: To explore the feasibility and cost of promoting fruit consumption among primary schoolchildren across Anglesey, a region in North Wales, UK. DESIGN, SETTING AND SUBJECTS: A postal survey of the head teachers of all 51 primary schools across Anglesey to ascertain their attitudes to promoting fruit consumption and current initiatives in place was conducted. This was followed by a 1-week pilot study in a single primary school to assess parents' support and willingness to bear or share costs, to determine children's fruit preferences, and to calculate fruit waste. Finally, the cost to local government of providing a piece of fruit to each primary schoolchild daily was calculated. RESULTS: A 53% response rate was obtained in the postal survey of primary school head teachers. All respondents expressed an interest in participating in future fruit promotion programmes. Of 27 primary schools, 26 that responded (96.3%) had programmes in place in which 18 had adopted specific food policies. In the pilot study at the single Anglesey primary school, a response rate of 97% from parents who expressed support for fruit promotion in school was obtained. Parents expressed their willingness to pay at least 15 pence per day towards fruit provision at break time for their children if such a service was not provided by local government. If local government was to invest in this initiative, the total cost of providing one piece of fruit per day to all primary school children in Anglesey would be 211,000 pounds per annum (2004 prices; 19 pence per child per day). CONCLUSION: This pilot study shows support by teachers and parents for initiatives to encourage primary schoolchildren to eat more fruit. Waste can be minimized by choosing fruit that children prefer, in this study, grapes, apples and oranges. The decision as to whether local government or parents are asked to pay for fruit provision is political, depending on local socioeconomic circumstances, local government priorities, national education and nutrition policies.     

我国成年人自评健康状况与脑卒中发病风险的前瞻性研究

目的分析我国成年人自评健康状况与脑卒中发病风险的关联。方法将2010年中国慢性病及其危险因素监测数据作为基线数据,从2010年监测点中选取11个省60个监测点(城市监测点25个、农村监测点35个)作为随访点,排除基线心血管病者,共36195人进入随访队列。2016-2017年进行随访调查,完成随访27441人。采用Cox比例风险回归模型分析自评健康状况与脑卒中发病风险比(HR),并按年龄、性别等基线特征进行亚组分析,剔除死亡者和基线糖尿病者进行敏感性分析。结果共纳入26699名研究对象进入分析,平均随访6.4年(共171431.1人年),随访期间共观察到脑卒中1332例(蛛网膜下腔出血32例,脑内出血197例,缺血性卒中1149例),发病密度为7.77/1000人年。多因素调整相关因素后,以自评健康非常好者为参照,自评健康差者脑卒中发病风险增加68%(HR=1.68,95%CI:1.22~2.32),缺血性卒中发病风险增加47%(HR=1.47,95%CI:1.05~2.05)。亚组分析发现年龄和BMI对自评健康与脑卒中发病风险间的关联存在效应修饰作用,年龄和血脂异常对自评健康与缺血性卒中发病存在修饰作用(交互P<0.05)。敏感性分析结果与全人群结果一致。结论自评健康状况差的人群发生脑卒中和缺血性卒中的风险增加,应将该人群,尤其是自评健康差的超重/肥胖、年龄<60岁或血脂异常人群作为重点干预对象。     

Preventing stroke in people with atrial fibrillation: a cross-sectional study

BACKGROUND: The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke. METHOD: Analysis of practice computer data taken from eight general practices (81 811 patients) in the south of England. 944 patients with a diagnosis of atrial fibrillation, of whom 782 (82.8 percent) were aged 65 years and over. RESULTS: The age standardised prevalence of diagnosed atrial fibrillation was 1.23 per cent (1.28 percent for men and 1.18 percent for women). It was much more prevalent in the older population, 8.28 percent and 6.66 percent for males and females over 65, respectively. Cardiovascular co-morbidities were more frequent with increasing age. Blood pressure (BP) was recorded in over 95 per cent of patients with atrial fibrillation though there was scope for improving control; 25 per cent of men and 31 per cent women had a BP over 150/90. Inconsistent recording of ECG and echocardiography made it hard to identify patients with left ventricular dysfunction. Forty six percent of men and 37 percent of women were either being prescribed Warfarin, or had contraindications to its use; of those on Warfarin 75.9 percent have an international normalized ratio in range. Forty four per cent were treated with aspirin. People at high risk of stroke were no more likely to be treated with Warfarin or aspirin than those at moderate risk. CONCLUSIONS: The rate of use of Warfarin remains low, and there is scope for better recording and management of risk factors particularly BP.     

The SEIQoL-DW is a valid method for measuring individual quality of life in stroke survivors attending a secondary prevention clinic

Objectives: This paper examines the applicability and construct validity of the Schedule for the Evaluation of Individual Quality of Life-Direct Weight (SEIQoL-DW) for measuring quality of life in stroke survivors living at home that attend a secondary prevention clinic. Participants and methods: Forty-six individuals attending a secondary prevention clinic following a stroke or transient ischaemic attack participated in a semi-structured interview to complete a range of outcome measures. Assessments of cognitive impairment, disability, and handicap were conducted using the Mini mental State Examination (MMSE), Barthel Index (BI), and Rankin Scale (RS). Measures to assess quality of life included perceived health status (PHS), Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the SEIQoL-DW. The construct validity of the SEIQoL-DW was assessed by correlation with the other measures. Results: According to the cues elicited from the SEIQoL-DW, participants nominated relationships with family and friends as the most important life domain, followed by social and leisure activities, and health. Spearmans rho correlation coefficients demonstrated significant relationships between the SEIQoL-DW index scores, PHS (r=0.35, p=0.016), VAMS (r=0.419, p=0.004), and the HADS anxiety (r=–0.546, p < 0.0001) and depression (r=–0.701, p < 0.0001) subscale scores. Conclusions: The SEIQoL-DW demonstrated reasonable construct validity for use in assessing individual quality of life in a group of individuals following stroke or TIA that attend a secondary prevention clinic.     

队列人群出血性卒中和缺血性卒中危险因素的对比研究

目的 分析与比较出血性卒中和缺血性卒中危险因素及其暴露水平的差异。方法 2003年在上海市奉贤区某农村社区建立卒中危险因素研究队列,对常见的卒中危险因素进行基线调查,检测脑血管血流动力学指标,按照统一的积分规则计算脑血管功能积分,随访卒中的发病。用队列研究的方法分析出血性卒中和缺血性卒中的危险因素,对2种亚型卒中的危险因素进行分析和比较。结果 纳入研究的队列人群10 565例,随访（11.15±2.26）年,新发生出血性卒中103例,缺血性卒中268例。脑血管功能积分降低、饮酒史、高血压病史和年龄升高是出血性卒中的独立危险因素,风险比（HR）值分别为1.56（95%CI：1.23~1.98）、2.46（95%CI：1.39~4.34）、1.75（95%CI：1.00~3.07）和1.07（95%CI：1.04~1.10）。脑血管功能积分降低、吸烟史、高血压病史、卒中家族史、左心室肥厚和年龄升高是缺血性卒中的独立危险因素,HR值分别为1.43（95%CI：1.25~1.65）、1.52（95%CI：1.13~2.05）、1.51（95%CI：1.10~2.07）、1.89（95%CI：1.13~3.15）、1.74（95%CI：1.07~2.81）和1.07（95%CI：1.05~1.08）。结论 脑血管功能积分降低、高血压病史、年龄升高是出血性卒中和缺血性卒中共同的独立危险因素,饮酒史是出血性卒中的独立危险因素,吸烟史、卒中家族史和左心室肥厚是缺血性卒中的独立危险因素。     

The use of formal and informal knowledge sources in patients’ treatment decisions in secondary stroke prevention: qualitative study

Background There is robust empirical evidence to support clinical decision making in secondary stroke prevention after transient ischaemic attack (TIA) or recovered stroke. However, little attention has been paid to patients’ utilization of this evidence in coming to decisions about their treatment choices. Objective To examine the use of formal and informal knowledge by patients in making decisions about carotid endarterectomy (CEA) and medical treatment after TIA/recovered stroke. Setting and participants Twenty participants were recruited from an outpatient vascular surgical assessment clinic in England. Ten were receiving medical treatment alone, and 10 were undergoing CEA after TIA or recovered stroke. Method Twenty‐eight in‐depth qualitative interviews were conducted. An iterative approach was used whereby emergent themes were further explored in later interviews. Interviews were audiotaped, transcribed and coded. Results Participants gathered and utilized several types of knowledge in the process of making treatment decisions: Empirical knowledge (e.g. clinical trial findings); Pathophysiologic findings (e.g. results of clinical investigations); Experiential knowledge (e.g. personal experience of stroke); Goals and values (e.g. potential impact on family); System features (e.g. apparent urgency of treatment). Conclusions In addition to formal evidence, patients use other sources of informal or ‘non‐evidentiary’ knowledge to support their decisions about treatment after TIA or recovered stroke. To enable evidence‐based patient choice, health professionals need to appreciate the diverse types of evidence which patients use, to help them to access relevant and high‐quality evidence, to balance evidence from different sources and to make choices which are congruent with their values and expectations.     

Risk factors for haemorrhagic stroke: a case–control study

A hospital based pair-matched case-control study was undertaken to identify risk factors for haemorrhagic stroke. The study took place in the Government Medical College Hospital, Nagpur, India, a tertiary care hospital. The study consisted of 166 hospitalised computerised tomography scan proved cases of haemorrhagic stroke (International Classification Diseases 9, 431–432), and an age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke.The study included hypertension, serum total cholesterol, alcohol intake, smoking, diabetes mellitus, obesity, physical inactivity, type A personality, use of anticoagulants/antiplatelets, family history of stroke, history of cardiac diseases, past history of transient ischaemic attack, history of claudication and oral contraceptive use in women, as risk factors for haemorrhagic stroke.Bivariate analysis included odds ratio (OR), 95% confidence intervals (CI) for OR and McNemar's χ² test. Multivariate analysis was carried out by conditional multiple logistic regression analysis. Attributable Risk Percent (ARP), Population Attributable Risk Percent (PARP) and their 95% CI were estimated for significant factors.On conditional multiple logistic regression five risk factors–hypertension (OR=1.9, 95% CI 1.5–2.5), serum total cholesterol (OR=2.3, 95% CI 1.4–4.9), use of anticoagulants and antiplatelet agents (OR=3.4, 95% CI 1.1–10.4), past history of transient ischaemic attack (OR=8.4, 95% CI 2.1–33.6) and alcohol intake (OR=2.1, 95% CI 1.3–3.6) were significant. Estimates of ARP and PARP for these factors confirmed their etiological and preventable role respectively.The current study recognised the significance of five risk factors, which are preventable. These risk factors may be considered for devising effective risk factor intervention strategy for haemorrhagic stroke.Public Health (2000) 114, 177–182     

Formal support of stroke survivors and their informal carers in the community: a cohort study

This cohort study, aims to explore formal care provision to stroke survivors and their informal carers in the community in the UK. An initial cohort of 105 cohabitant carers of first-time stroke patients was recruited while the stroke patient was in hospital. Structured face-to-face interviews were carried out with carers prior to discharge of the stroke patient home, at 6 weeks after discharge, and 15 months after stroke. Questionnaires included measures of psychological health (CIS-R), physical health (self-rated health), social well-being (relationship quality and Sarason's social support questionnaire), handicap of the stroke survivor (Oxford Handicap Scale) and formal community support (amount of formal support and carer satisfaction). Multiple services were involved with most survivor-carer pairs (mean 5.4; range 2-9; SD = 1.7), and 74% of carers were satisfied with formal support provided. Number of services decreased with time (5.5 versus 4.1, t = 4.201, d.f. = 52, P < 0.001, 95% confidence interval: 0.71-2.01) but not time allocated. Using stepwise linear regression, service provision early after discharge was predicted by: level of handicap, recruitment centre, carer self-rated health, number of informal supporters and other care commitments. Satisfaction was predicted by quality of informal support and activity restriction. Fifteen months after stroke, predictors of formal care were: level of handicap, quality of informal support and previous caring experience. Predictors of satisfaction were: quality of the relationship between the stroke survivor and carer, age and mood. Quality of services was good, but carers lacked information, had insufficient help and were not consulted enough. Carer distress is common, yet not currently a factor influencing support provision. Formal care provided adapts with time reflecting the importance of quality of support from friends and family rather than quantity of informal supporters. These factors should be taken into consideration when planning and providing formal support for stroke survivors and their carers.     

A pilot study of an online workplace nutrition program: the value of participant input in program development

ObjectiveTailored nutrition Web programs constitute an emerging trend in obesity prevention. Initial investment in innovative technology necessitates that the target population be well understood. This pilot study's purpose was to determine the feasibility of a workplace nutrition Web program.DesignFormative research was conducted with gaming industry employees and benefits managers to develop a consensus on workplace-specific nutrition needs. A demonstration Web program was piloted with stakeholders to determine feasibility.SettingIndiana, Mississippi, Nevada, and New Jersey gaming establishments.Participants86 employees, 18 benefits managers.InterventionPrototype Web program.Main Outcome MeasuresConcept mapping; 16-item nutrition knowledge test; satisfaction.AnalysisConcept mapping was used to aggregate importance ratings on programmatic content, which informed Web program curriculum. Chi-square tests were performed postintervention to determine knowledge improvement.Results(1) Employees and benefits managers exhibited moderate agreement about content priorities for the program (r = 0.48). (2) There was a significant increase in employees' nutrition knowledge scores postintervention (t = 7.16, df = 36, P < .001); those with less knowledge exhibited the greatest gains in knowledge scores (r = −0.647, P < .001).Conclusions and ImplicationsEmployees and benefit managers do not necessarily agree on the priority of nutrition-related content, suggesting a need for programs to appeal to various stakeholders. Computer-based approaches can address various stakeholder health concerns via tailored, customized programming.     

血栓弹力图指导脑卒中二级预防临床研究

目的应用血栓弹力图(thrombelastography,TGE)监测缺血性脑卒中(cerebral ischemic stroke)患者阿司匹林和氯吡格雷用药过程中花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率的变化情况并进行指导用药,探讨其在脑卒中的监测和二级预防价值。方法将我院80例确诊为缺血性脑卒中患者根据用药分为阿司匹林组(36例)和氯吡格雷组(44例),通过TEG-5000监测患者在治疗14 d后血小板抑制率变化确定出药物抵抗患者,对产生药物抵抗的患者改服另一类型药物(阿司匹林或氯吡格雷)后在7 d后再次使用TEG监测血小板抑制率。结果前期确定为阿司匹林抵抗型或氯吡格雷抵抗型患者在改服用另一药后,AA和ADP途径诱导的血小板抑制率相比之前都有极显著性的提高(P0.01),具有统计学意义,说明TEG检测指导用药效果显著。另外,在两组药物抵抗组中的女性患者改服另一药物后用药效果显著优于男性患者,原因可能是更多男性脑卒中患者有高血压史、吸烟史和饮酒史等危险因素。结论 TEG技术能快速、准确地检测脑卒中患者服用阿司匹林及氯吡格雷后的血小板抑制率(AA%或ADP%),评估患者对不同抗血小板药物的反应性,从而为进一步制定个体化抗血小板治疗策略、指导脑卒中二级预防提供有效手段。     

Utilization of mental health services by survivors of severe paediatric traumatic brain injury: a population-based study

A study of general and specialist mental health and psychology service provider records confirms very high rates of utilization by a population of survivors of severe paediatric traumatic brain injury.