Driver licensing: descriptive epidemiology of a social determinant of Aboriginal and Torres Strait Islander health

Objective : Education, employment and equitable access to services are commonly accepted as important underlying social determinants of health. For most Australians, access to health, education and other services is facilitated by private transport and a driver licence. This study aimed to examine licensing rates and predictors of licensing in a sample of Aboriginal and Torres Strait Islander people, as these have previously been poorly described. Methods : Interviewer‐administered surveys were conducted with 625 people 16 years or older in four Aboriginal Community Controlled Health Services in New South Wales and South Australia over a two‐week period in 2012–2013. Results : Licensing rates varied from 51% to 77% by site. Compared to not having a licence, having a driver licence was significantly associated with higher odds of full‐time employment (adjusted OR 4.0, 95%CI 2.5–6.3) and educational attainment (adjusted OR 1.9, 95%CI 1.2–2.8 for trade or certificate; adjusted OR 4.0, 95%CI 1.6–9.5 for degree qualification). Conclusions : Variation in driver licensing rates suggests different yet pervasive barriers to access. There is a strong association between driver licensing, education and employment. Implications : Licensing inequality has far‐reaching impacts on the broader health and wellbeing of Aboriginal and Torres Strait Islander people, reinforcing the need for appropriate and accessible pathways to achieving and maintaining driver licensing.     

Iron supplement in pregnancy and development of gestational diabetes—a randomised placebo-controlled trial

Objective  To test the hypothesis that iron supplement from early pregnancy would increase the risk of gestational diabetes mellitus (GDM).
Design  Randomised placebo-controlled trial.
Setting  A university teaching hospital in Hong Kong.
Population  One thousand one hundred sixty-four women with singleton pregnancy at less than 16 weeks of gestation with haemoglobin (Hb) level between 8 and 14 g/dl and no pre-existing diabetes or haemoglobinopathies.
Methods  Women were randomly allocated to receive 60 mg of iron supplement daily ( n = 565) or placebo ( n = 599). Oral glucose tolerance tests (OGTTs) were performed at 28 and 36 weeks. Women were followed up until delivery.
Outcome measures  The primary outcome was development of GDM at 28 weeks. The secondary outcomes were 2-hour post-OGTT glucose levels, development of GDM at 36 weeks and delivery and infant outcomes.
Results  There was no significant difference in the incidence of GDM in the iron supplement and placebo groups at 28 weeks (OR: 1.04, 95% confidence interval [CI]: 0.7–1.53 at 90% power) or 36 weeks. Maternal Hb and ferritin levels were higher in the iron supplement group at delivery ( P < 0.001 and P = 0.003, respectively). Elective caesarean section rate was lower in the iron supplement group (OR: 0.58, 95% CI: 0.37–0.89). Infant birthweight was heavier ( P = 0.001), and there were fewer small-for-gestational-age babies in the iron supplement group (OR: 0.46, 95% CI: 0.24–0.85).
Conclusion  Iron supplement from early pregnancy does not increase the risk of GDM. It may have benefits in terms of pregnancy outcomes.     

Living with Marfan syndrome I. Perceptions of the condition

We present data from an exploratory study of 174 adults with Marfan syndrome regarding their cognitive perceptions of the condition as postulated by the self-regulatory model (Leventhal H, Benyamini Y, Brownlee S et al. In: Petrie KI, Weinman JA, eds. Perceptions of Health and Illness: Current Research and Applications. Amsterdam, The Netherlands: Harwood Academic, 1997: 19-45; Leventhal H, Nerenz DR, Steele DJ. In: Baum A, Taylor SE, Singer JE, eds. Handbook of Psychology and Health. Hillsdale, NJ: Lawrence Erlbaum Associates, 1984: 219-252). The vast majority of the respondents had adequate general knowledge about Marfan syndrome. Eighty-three percent of the respondents perceived Marfan syndrome as having had significant adverse consequences on their lives. Having striae, pain (sore joints), and depression were each independently correlated with this view. Fifty-eight percent of the respondents indicated that they felt they had low to moderate control over their condition, demonstrating variability. History of aortic dissection, pain (sore joints), and depressive symptoms were each negatively correlated with the view that Marfan syndrome is a curable/controllable condition. Moreover, approximately 28% view the condition as a lethal condition, whereas 67% view it as a serious condition. Forty-four percent of the cohort were found to have significant symptomatology of depression independent of beta- and Ca2+-channel blockade use. Respondents cited both advantages and disadvantages of being affected. Genetic counseling that addresses patients' perceptions of Marfan syndrome, and its associated pain, fatigue, and depressive symptoms, may enhance patient adaptation to the condition.     

Risk of cardiovascular thrombotic events after surgical castration versus gonadotropin-releasing hormone agonists in Chinese men with prostate cancer

We investigated the cardiovascular thrombotic risk after surgical castration (SC) versus gonadotropin-releasing hormone agonists (GnRHa) in Chinese men with prostate cancer. All Chinese prostate cancer patients who were treated with SC or GnRHa from year 2000 to 2009 were reviewed and compared. The primary outcome was any new-onset of cardiovascular thrombotic events after SC or GnRHa, which was defined as any event of acute myocardial infarction or ischemic stroke. The risk of new-onset cardiovascular thrombotic event was compared between the SC group and the GnRHa group using Kaplan–Meier method. Multivariate Cox regression analysis was performed to adjust for other potential confounding factors. A total of 684 Chinese patients was included in our study, including 387 patients in the SC group and 297 patients in the GnRHa group. The mean age in the SC group (75.3 ± 7.5 years) was significantly higher than the GnRHa group (71.8 ± 8.3 years) (P < 0.001). There was increased risk of new cardiovascular thrombotic events in the SC group when compared to the GnRHa group upon Kaplan–Meier analysis (P = 0.014). Upon multivariate Cox regression analysis, age (hazard ratio [HR] 1.072, 95% confidence interval [CI] 1.04–1.11, P< 0.001), hyperlipidemia (HR 2.455, 95% CI 1.53–3.93, P< 0.001), and SC (HR 1.648, 95% CI 1.05–2.59, P = 0.031) were significant risk factors of cardiovascular thrombotic events. In conclusion, SC was associated with increased risk of cardiovascular thrombotic events when compared to GnRHa. This is an important aspect to consider while deciding on the method of androgen deprivation therapy, especially in elderly men with known history of hyperlipidemia.     

Haemodynamic differences between cromakalim and pinacidil: comparison with nifedipine

The effects of cromakalim (0.015, 0.03 and 0.06 mg kg-1 p.o.), pinacidil (0.3, 0.6 and 1.2 mg kg-1 p.o.) and nifedipine (0.15, 0.3 and 0.6 mg kg-1 p.o.) were compared on mean arterial pressure (MAP), heart rate (HR), mean renal blood flow (MRBF) and plasma renin activity (PRA) in the conscious normotensive cat. All drugs elicited dose-related falls in MAP with cromakalim being about 10 times more potent than nifedipine or pinacidil, the latter two drugs being equipotent. For similar reductions in MAP, the increases in HR and PRA produced by cromakalim were significantly smaller than those produced by either nifedipine or pinacidil. Cromakalim (0.015-0.06 mg kg-1 p.o) elicited dose-related increases in MRBF with the peak effect occurring 2-2.5 h post-dose. Thereafter, MRBF recovered toward pretreatment levels despite MAP being almost maximally reduced. Neither nifedipine nor pinacidil affected MRBF though nifedipine (0.3 mg/kg-1 p.o.) caused a significant reduction in renal vascular resistance. This study has shown that important haemodynamic differences exist between cromakalim, nifedipine and pinacidil suggesting that increased MRBF is not a general property of K+ channel activation or of Ca2+ slow channel blockade.     

Identification and subcellular localization of a putative cell-to-cell transport protein from red clover mottle virus

To investigate the mode of gene expression of red clover mottle virus (RCMV) middle component (M) RNA, we have synthesized an oligopeptide corresponding to the predicted carboxy-terminus of the RCMV counterparts of the cowpea mosaic virus (CPMV) 48K and 58K proteins. Using an antiserum raised against this synthetic oligopeptide, we have detected a 43-kDa protein in the 30,000 g pellet from extracts of RCMV-infected cowpea protoplasts. Immunogold cytochemistry further localized this protein to the plasmodesmata of RCMV-infected pea tissue. This subcellular location, taken together with other evidence, suggests that this 43-kDa protein has a role in the cell-to-cell spread of RCMV.     

Psycho‐socio‐economic outcomes in acoustic neuroma patients and their carers related to tumour size

The objective was to explore psycho‐socio‐economic outcomes of a 2‐year cohort of patients having surgery for an acoustic neuroma, and carers and their relationship to tumour size after surgery. The Wessex Patient Carer Questionnaire was designed in conjunction with Patients and Carers, to determine psycho‐socio‐economic outcomes. The results were juxtaposed against clinical profiles. The House–Brackman (HB) scale was used to assess facial function at 6 and 12 months after operation. The cohort contained 102 patients. There were 87% effective responders. Half were aged below 54 years and 30% had school‐aged children. The majority (93%) of patients were operated via the translabyrinthine approach. Patients with large tumours, i.e. greater than 3 cm (28%), had most post‐treatment physical problems, including hearing and balance difficulties, and 42% reported difficulty eating in public. Thirty‐four per cent felt ‘stressed’ and 18%‘depressed’. After 6 months, facial function was recorded as HB scale 5/6 in 21% of patients but by 1 year only 8% of patients were HB 5/6. Patients and carers were generally very satisfied with their in‐patient neurosurgical care, but significantly dissatisfied with post‐discharge care – particularly the shortcoming of the community services. The majority of families felt ‘unsupported’ and only 20% of patients had confidence in their General Practitioner's knowledge. Families faced severe socio‐economic disruption and patients’‘time‐off‐work’ was estimated to cost £954 000. Carers carried considerable post‐discharge psychological burdens and costs to the public purse were calculated to be £52 400.