Can the impact on health of a government policy designed to create more liveable neighbourhoods be evaluated? An overview of the RESIDential Environment Project

There is growing interest in the impact of community design on the health of residents. In 1998, the Western Australian Government began a trial of new subdivision design codes (i.e. Liveable Neighbourhoods Community Design Code) aimed at creating pedestrian-friendly neighbourhoods to increase walking, cycling and public transport use. The trial provided a unique opportunity for a natural experiment to evaluate the impact of a government planning policy on residents. Nevertheless, evaluations of this kind present a number of methodological challenges in obtaining the highest quality evidence possible. This paper describes the RESIDential Environment Project's study design and discusses how various methodological challenges were overcome.     

Using postal randomization to replace telephone randomization had no significant effect on recruitment of patients

OBJECTIVE: To test the effect of postal randomization on recruitment of patients into a randomized trial in primary care. STUDY DESIGN AND SETTING: General practices used a telephone service to randomize patients in our trial. Delays in the start of recruitment at some sites led us to modify the randomization procedure. When new practices took part patients completed and posted baseline materials to the Trial Secretary in York who performed the randomization and informed those concerned of the allocation. RESULTS: Of the 647 practices who were invited to take part, 130 (45%) of 288 agreed to participate using telephone randomization and 155 (43%) of 359 using the postal method. These practices recruited 553 patients from November 2002 to October 2004 across 11 sites in the United Kingdom. The postal method reduced the number of patients recruited by a factor of 0.86 (95% confidence interval=0.62-1.20), or 14%. The number of general practitioners working in a practice significantly increased patient recruitment by a factor of 1.12 (1.05-1.20), whereas practice distance from hospital significantly decreased recruitment by a factor of 0.98 (0.97-0.99). CONCLUSION: Postal randomization had no significant effect on recruitment of patients into our trial.     

Supplementation of a high-carbohydrate breakfast with barley beta-glucan improves postprandial glycaemic response for meals but not beverages

There is growing support for the protective role of soluble fibre in type II diabetes. Soluble fibre beta-glucan found in cereal products including oats and barley may be the active component. There is evidence of postprandial blunting of blood glucose and insulin responses to dietary carbohydrates when oat soluble fibre is supplemented into the diet but few trials have been carried out using natural barley or enriched barley beta-glucan products. The aim of this trial was to investigate the postprandial effect of a highly enriched barley beta -glucan product on blood glucose, insulin and lipids when given with a high-CHO food and a high-CHO drink. 18 lean, healthy men completed a 4 treatment intervention trial comprising (i) high-CHO(food control), (ii) high-CHO(food+fibre), (iii) high-CHO(drink control), (iv) high-CHO(drink+fibre) where a 10g dose of barley beta-glucan fibre supplement (Cerogen) containing 6.31g beta-glucan was added to food and drink controls. There was an increase of glucose and insulin following all 4 treatments. Addition of the beta -glucan supplement significantly blunted the glycaemic and insulinaemic responses on the food (p<0.05) but not drink (p>0.05) treatments when compared to controls. The high-CHO breakfasts decreased total, LDL- and HDL-cholesterol from baseline to 60 mins postprandially but there were no differential effects of beta-glucan treatment on circulating lipids. We conclude that a high dose barley beta-glucan supplement can improve glucose control when added to a high-CHO starchy food, probably due to increased gastro-intestinal viscosity, but not when added to a high-CHO beverage where rapid absorption combined with decreased beta-glucan concentration and viscosity may obviate this mechanism.     

Age-related changes in hookworm infection, anaemia and iron deficiency in an area of high Necator americanus hookworm transmission in south-eastern Brazil

Surprisingly few detailed age-stratified data exist on the epidemiology of hookworm and iron status, especially in Latin America. We present data from a cross-sectional survey examining 1332 individuals aged 0-86 years from a community in south-east Brazil for hookworm, anaemia and iron deficiency. Sixty-eight percent of individuals were infected with the human hookworm Necator americanus. The force of infection (lambda=0.354) was similar to estimates from other areas of high hookworm transmission. Individuals from poorer households had significantly higher prevalence and intensity of infection than individuals from better-off households. The prevalence of anaemia, iron deficiency and iron-deficiency anaemia was 11.8%, 12.7% and 4.3%, respectively. Anaemia was most prevalent among young children and the elderly. Univariate analysis showed that haemoglobin and serum ferritin were both significantly negatively associated with hookworm intensity among both school-aged children and adults. Multivariate analysis showed that, after controlling for socio-economic status, iron indicators were significantly associated with heavy hookworm infection. Our results indicate that, even in areas where there is a low overall prevalence of anaemia, hookworm can still have an important impact on host iron status, especially in school-aged children and the elderly.     

Cases of typhoid fever imported into England, Scotland and Wales (2000-2003)

Although typhoid fever is no longer endemic in most of the developed world, it remains a major infectious disease in less developed regions and imported cases continue to occur in returning travellers, immigrants or migrant workers. We analysed all 692 isolates of Salmonella enterica subspecies enterica serovar Typhi from cases in England, Scotland and Wales that were sent to the Laboratory of Enteric Pathogens at the Health Protection Agency, Centre for Infections, London, UK between 2000 and 2003. The country of acquisition was known for 416 isolates (60%), and the majority of these (70%) came from India or Pakistan. Overall, 24 countries were listed, mainly in Asia and Africa. A total of 48 phage types were detected, 41% of which were Vi-phage type E1. Antimicrobial susceptibility testing revealed that 22% of isolates were multidrug resistant (MDR) (defined as resistance to chloramphenicol, ampicillin and co-trimoxazole) and 39% were quinolone resistant. A significant number of isolates (n=49) were sensitive to nalidixic acid by disk test but exhibited low-level ciprofloxacin resistance, suggesting a novel mechanism of resistance and reinforcing the need for minimum inhibitory concentration determination. Overall, 13% of isolates were both MDR and likely to show a poor response to a fluoroquinolone. A third-generation cephalosporin (e.g. ceftriaxone) should be considered as empirical therapy in regions of the Indian subcontinent where resistance is now at high levels as well as in patients returning from these areas. This study helps to describe the epidemiology of antimicrobial drug resistance in typhoid fever.     

Breast cancer incidence and early diagnosis in a family history risk and prevention clinic: 33-year experience in 14,311 women

Breast Cancer Research and Treatment - Women at increased familial breast cancer risk have been offered screening starting at an earlier age and increased frequency than national Screening...     

Diffusion of cancer education information through a Latino community health advisor program

OBJECTIVE: To examine diffusion of breast and cervical cancer screening information through a community health advisor program targeting Latino women of low socioeconomic level and low level of acculturation in San Diego, California. METHOD: Seventeen community health advisors ("consejeras") were recruited and trained to conduct educational group sessions. Each consejera recruited peers from the community to participate in the 12 sequential weekly sessions (i.e., primary participants). In addition, each of the primary participants identified up to two friends and/or family members (i.e., "learning partners") with whom they intended to share the cancer education information received. Pretest and posttest telephone surveys were conducted between 1996 and 1997. A total of 311 primary participants completed the pretest and 285 the posttest. Among the learning partners, 269 completed the pretest and 222 the posttest. RESULTS: Knowledge about breast and cervical cancer and self-reported use of screening tests increased among primary participants and learning partners. However, the increase was not statistically significant in mammography screening among participants 40 years old or older. Overall, increases in knowledge were more pronounced among primary participants when compared to learning partners. CONCLUSION: The utilization of the learning partner model represents a promising diffusion tool to enhance cancer early detection programs relying on community health advisors.     

Effects of leptin on intake of specific micro- and macronutrients in a woman with leptin gene deficiency studied off and on leptin at stable body weight

In this report, we examine the effects of leptin on the intake of specific macro- and micronutrients in a female patient with leptin gene deficiency. The patient was studied off and on leptin at stable body weight, within the normal to mildly overweight range. The data were obtained by detailed dietary assessments, measuring dietary intakes by weighed food and fluid consumption records, and analyzed using nutrition analysis software. Overall, significant differences were found in the off versus on leptin treatment periods in the following categories: (i) macronutrients: kilocalories, protein, carbohydrates, monounsaturated fats, MFA 18:1 oleic and total fiber; (ii) vitamins: vitamin C, pyridoxine and pantothenic acid; (iii) minerals: potassium, magnesium, copper and chromium; and amino acids: threonine, lysine and histidine. The nutritional data from this study indicates a direct link between the effects of leptin and ingestion of several specific micronutrients. The mechanisms underlying these effects warrant further investigation and study.     

'I wouldn't have been interested in just sitting round a table talking about cancer'; exploring the experiences of women with breast cancer in a group exercise trial

There is evidence that physical activity improves the psychological and physical health of patients with cancer. However, relatively little attention has been paid to understanding their experiences of exercise. This focus group study explored the experiences of women undergoing treatment for breast cancer who had taken part in a supervised group exercise trial. We found that setting up classes solely for women with breast cancer, led by an expert instructor, helped to reduce gender-related barriers to physical activity, such as difficulties in prioritizing exercise over caring roles and worries about changed appearance. For example, some women challenged traditional expectations of femininity by removing their wigs in the classes in order to exercise in comfort. Respondents valued exercising with women in the 'same boat' because of the empathy and acceptance they received and the opportunities to exchange information and form friendships. However, the action-orientated format of the group was preferred to a talk-based format such as a support group; some respondents felt that the 'last thing' they wished to do was to talk about cancer. Our findings therefore challenge stereotypes about women invariably preferring to cope with cancer through emotional disclosure.     

Programme-related stressors among part-time undergraduate nursing students

AIM: The aim of this paper is to report a study exploring the perceived stressors identified by a group of 70 students who undertook a part-time degree at one Irish university. BACKGROUND: In the literature on stress, part-time nursing students who are undertaking continuing education programmes appear to have received little attention. Stress amongst nurses is evident within the nursing literature but little information is available on the specific stressors that affect Registered Nurses who undertake further academic study. Anecdotally, students attending part-time programmes while working full-time report high levels of stress. METHOD: Quantitative methods were used. While many instruments exist to measure overall stress, this study aimed to explore student's perceptions of specific stressors associated with academic study. We used a questionnaire developed from the literature on the topic. RESULTS: Factors related to writing assignments at degree level, fulfilling personal needs and academic demands, were perceived as major stressors by these students. Factors of little concern were financial issues and attendance on the programme. Individual items receiving highest mean scores were: trying to balance work commitments and the required study (mean 3.89, sd = 1) and the prospect of the final examination (mean 3.86, sd = 1). This study was limited by the use of convenience sampling and self-report methods. Larger studies are required to support the findings. In addition, student stress was not observed or measured. CONCLUSION: Those involved in the delivery of nurse education programmes to part-time students need to consider the impact of the workload on student welfare, and to prepare students for demands of the programme.