The prevention access and risk taking in young people (PARTY) project protocol: a cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice and motivational interviewing for young people presenting to general practice

ABSTRACT: BACKGROUND: There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. Main outcomes: clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking. Secondary outcomes: pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol. METHODS: PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff's self-perceived competency in young people's care and clinicians' detection and response to risk taking behaviours and emotional distress in 14-24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people were interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation. DISCUSSION: The PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months. Trial registration ISRCTN16059206 Key Words Young people, health risks, screening, motivational interviewing, emotional distress, primary care, health outcomes.     

Intestinal Obstruction Due to Volvulus of the Colon

A survey of 276 cases of acute intestinal obstruction showed that volvulus was responsible for 8.6 per cent. Forty-six cases of volvulus of the colon are reviewed.

The authors feel that right hemicolectomy with ileotransverse colostomy is the procedure of choice in volvulus of the right colon; anterior resection with end to end anastomosis, whenever possible, is preferred in lesions involving the sigmoid colon.     

Effect of a novel series of macrocyclic hypolipidemic agents on plasma lipid and lipoprotein levels of four non-primate species.

The ansamycins are structurally novel hypolipidemic agents derived from rifampicin, but lacking antibacterial activity. Oral or intravenous administration resulted in rapid lowering of plasma cholesterol in rats, hamsters, guinea pigs and dogs. In the chow-fed rat, three related compounds (CGP 43371, CGS 23810 and CGS 24565) exhibited ED50 values of 13.7, 3.1 and 0.18 mg/kg, respectively. A feature common to the lipid lowering documented in these four species was the concomitant reduction of low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol. In the chow-fed rat, however, apolipoprotein AI (apo AI) levels were much less affected than were those of HDL cholesterol. CGP 43371 at 3 and 10 mg/kg, lowered HDL cholesterol by 20% and 39%, respectively, whereas plasma apo AI was reduced by only 1% and 12%. Similarly, in lipoprotein fractions separated by ultracentrifugation, apo AI was unchanged in the d = 1.019-1.21 g/ml fraction after treatment with 3 or 10 mg/kg of CGP 43371, but HDL cholesterol was reduced 12% and 26% in this fraction at the two dose levels. Plasma and lipoprotein apo B levels, on the other hand, were reduced to a level equivalent to that of the reduction in cholesterol. The ansamycins thus represent a new structural series which may possess a novel mechanism of action as well, involving differential effects on HDL cholesterol and protein.     

Biochemical and genetic characterization of multiple splice variants of the Flt3 ligand

We have performed a comprehensive analysis of cell lines and tissues to compare and contrast the expression patterns of Flt3 ligand (FL), c-Kit ligand (KL), and macrophage colony-stimulating factor as well as their receptors, Flt3, c-Kit, and c-Fms. The message for FL is unusually ubiquitous, whereas that of its receptor is quite restricted, apparently limiting the function of the ligand to fetal development and early hematopoiesis. We have also sequenced a mouse FL genomic clone, revealing how the three splice variant FL mRNAs that we have isolated arise. The chromosomal location of the FL gene has been mapped, by in situ hybridization, to chromosome 7 in mouse and chromosome 19 in human. Natural FL protein has been purified from a stromal cell line and shown to be a 65 kD nondisulfide-linked homodimeric glycoprotein comprised of 30 kD subunits, each containing 12 kD of N- and O-linked sugars. Pulse-chase experiments show that one of the splice variants (T110) is responsible for producing the bulk of soluble FL, but only after it has first been expressed at the cell surface as a membrane- bound form. The other splice-variant forms produce molecules that are either obligatorily soluble (T169) or membrane-bound but released only very slowly (T118). Finally, even though most cell lines express some amount of FL mRNA, we found that very little FL protein is actually made, with T cells and stromal cells being the major producers. The data suggests that FL plays its roles over very short distances, perhaps requiring cell-cell contact.     

Kinetics of mobilization of neutrophils and their marrow pool in protein-calorie deficiency

Migration of marrow neutrophils under basal conditions and their mobilization, following subcutaneous implantation of cover slips, were investigated in groups of protein-deficient rats, using 3HTdR with sequential autoradiography of the peripheral blood smears. Animals fed a protein-rich diet served as controls. The pattern of appearance of labeled neutrophils in the blood was identical in the two groups under basal conditions. However, a higher percentag of labeled neutrophils appeared earlier in the blood following cover slip implantation in the deficient rats as compared to controls. The inflammatory exudate on the cover slips was low throughout the period of observation in deficient animals, with a delay in the appearance of monocytes. A pool of mature neutrophils resides in the bone marrow. It is proposed that in PCM there is atrophy of all neutrophil compartments, including that of the marrow pool, associated with a proportionate reduction in the efflux of cells from one compartment to another. This proportionate reduction in efflux would explain the normal kinetics of migration of neutrophils under basal conditions in the deficient rats in spite of a reduction in the marrow pool. On the other hand, in cover slip-implanted deficient rats, appearance of larger numbers of labeled neutrophils in the blood is attributed to a reduction in size of the marrow pool. This hypothesis is substantiated by the experiments in protein-deficient monkeys in which estimation of the marrow pool of neutrophils revealed a marked reduction in the deficient animals. It is further proposed that a diminuation of the marrow pool of neutrophils and retarded mobilization of cells at the site of inflammation are important mechanism responsible for the increased susceptibility of the malnourished host to infections.