Evaluating projects funded by the Western Australian Health Promotion Foundation: first results

The paper describes output measures of performance of the WesternAustralian Health Promotion Foundation (Healthway), using asystem known as graduated project evaluation (GPE). Resultsare reported at the basic and process levels of evaluation on588 health and sponsorship projects, and at the impact levelbased on surveys of 5710 spectators and participants at 53 sport,arts and racing events sponsored by Healthway funds. At thebasic and process levels the average Healthway project reached7449 people directly and generated media coverage of healthmessages on 27.3 occasions. It secured, on average, 0.99 healthystructural reforms in recreational or cultural venues, involvedthe participation of local community members in project administrationin 38% of instances, and provided 1596 person-hours of healtheducation. Non-smoking, safe drinking, nutrition, exercise,sun protection, safe sex and injury prevention health messageswere promoted using 24 different types of sponsor benefits.Of the 5710 respondents surveyed post-event, 67% were awareof the promoted health message and 82% of these understood whatthe message meant. Four per cent of all respondents intendedto take action ranging from seeking information to adoptingthe health behaviour. A comparison of the cost-effectivenessof small and large sponsorship projects is given to illustratethe use of GPE to inform funding decisions. Smaller projectsoutperformed larger projects on all available indicators. Wediscuss the peculiar features of the health promotion foundationconcept, methods to improve its performance and implicationsfor future research.     

FINDING MEANING IN A CHILD'S VIOLENT DEATH: A FIVE-YEAR PROSPECTIVE ANALYSIS OF PARENTS' PERSONAL NARRATIVES AND EMPIRICAL DATA

Finding meaning in the death of a loved one is thought to be extremely traumatic when the circumstances surrounding the death is perceived to be due to negligence, is intentional, and when the deceased suffered extreme pain and bodily harm immediately prior to death. We addressed this assumption by obtaining personal narratives and empirical data from 138 parents 4, 12, 24, and 60 months after an adolescent's or young adult child's death by accident, suicide, or homicide. Using the Janoff-Bulman and Frantz's(1997) framework ofmeaning-as-comprehensibility and meaning-as-significance, the purposes were to identify the time course to find meaning, present parents' personal narratives describing finding meaning in their experiences, identify predictors of finding meaning, and compare parents who found meaning versus those who did not on five health and adjustment outcomes. The results showed that by 12 months postdeath, only 12% of the study sample had found meaning in a child's death. By 60 months postdeath, 57% of the parents had found meaning but 43% had not. Significant predictors of finding meaning 5 years postdeath were the use of religious coping and support group attendance. Parents who attended abereavement support group were 4 times more likely to find meaning than parents who did not attend. Parents who found meaning in the deaths of their children reported significantly lower scores on mental distress, higher marital satisfaction, and better physical health than parents who were unable to find meaning. Recommendations for future research are made.     

Right Bundle Branch Block of Unknown Age in the Setting of Acute Anterior Myocardial Infarction: An Attempt to Define Who Should Be Paced Prophylactically

It is widely accepted that patients presenting with acute anterior myocardial infarction and acute onset of right bundle branch block should be prophylactically paced in contrast with those who have a chronic bundle branch block. The admitting physician is faced with the dilemma of how to act if the age of this conduction disturbance is unknown. This problem has further intensified in recent years, with the introduction of thrombolytic treatment, where insertion of a central vascular line is associated with increased morbidity. The objectives of this study were to define clinical or electrocardiographic parameters that may help the admitting physician to decide whether patients presenting with an anterior wall myocardial infarction and a right bundle branch block of unknown age should be prophylactically paced. We examined prospectively the in-hospital clinical course of 39 consecutive patients presenting with an acute myocardial infarction in whom the age of a right bundle branch block upon admission was unknown (group C, n = 39) and compared it with two similar groups of patients who presented with an acute right bundle branch block (group A, n = 38) and with a known chronic right bundle branch block (group B, n = 22). Thirty-three patients (33%) died, with cardiogenic shock being the leading cause of death in the entire population. Prophylactic pacing, which was carried out in 66% and 54% of patients in groups A and C, respectively, did not reduce mortality rates. No clinical or electrocardiographic variables on admission were predictive to support prophylactic pacing in group C. In 10 of 46 (22%) patients who were prophylactically paced with a transvenous electrode, the following complications attributed to the procedure were detected: (1) either rapid sustained ventricular tachycardia (during implantation) that was unresponsive to overdrive pacing, or ventricular fibrillation necessitating electrical defibrillation (4 patients); (2) recurrent episodes of rapid nonsustained ventricular tachycardia, which stopped only after the pacemaker was turned off (1 patient); (3) complete AV block (1 patient); (4) fever appearing on the third or fourth day after implantation (3 patients); and (4) a large hematoma in the groin in 1 patient who was treated with thrombolysis shortly before pacemaker electrode insertion. Thus, the complications of transvenous temporary pacing in the era of thrombolysis may outweigh any theoretical advantage. (PACE 1995; 18:1496-1508)     

DIURETIC RADIONUCLIDE RENOGRAPHY IN UPPER URINARY TRACT OBSTRUCTION

Diuretic renography using radioidine sodium hippurate and a frusemide stimulus was used to differentiate between obstructive and nonobstructive dilatation of the urinary tract. Information was recorded by a gamma camera on line to a computer. Sixty-seven uretero-renal units (URU) were studied in 33 patients with an average age of 9¹/₂ years. The diuretic renogram correctly indicated obstructions in 18 URU but gave false positive results in another five. Of these five, four had severely Impaired function. The renogram indicated nonobstruction in 49 URU, and gave false negative results in another two; of these two one patient had a duplex kidney with a poorly functioning ureteric segment and the other patient had gross reflux and megaureters. The diuretic renogram is useful in the investigation of equivocal upper urinary tract obstruction but may be unreliable in situations of inadequate renal function.     

The adenosine triphosphate content and lactic acid production of guinea-pig skin after mild heat damage

The depletion of adenosine triphosphate in skin after mild thermal injury is not large enough to be accounted for by loss of oxidative respiration. Measurement of lactic acid production by skin suggest that glycolysis is less sensitive to heat damage than is oxygen uptake. It is therefore likely that glycolysis makes a large contribution to the relatively high levels of ATP persisting in heat damaged skin.     

DFP Labeling of Platelets During Recovery from Thrombocytopenia

Rat platelets were labeled with tritiated diisopropylfluorophosphate(³H-DFP) during recovery from acute thrombocytopenia. The results indicated that there was significant labeling of megakaryocytes by ³H-DFPwhich, in the presence of an increased rate of platelet production, resulted inmaintenance of relatively constant values for platelet-bound radioactivity during the period of maximum platelet production and reactive thrombocytosis.Significant random loss of platelets was apparent, and, when a cohort ofyoung platelets was transfused to normal recipients, they were destroyed at anormal rate.

     

The effect of dental education and dental treatment on the dental status of a handicapped population: a longitudinal study

Thirty-nine patients, aged 3 to 22, who have handicapping conditions were examined twice in a range of 1 1/2 years to determine oral hygiene level, periodontal treatment needs, and level of caries. During this period, each patient was given periodontal treatment, including scaling, caries treatment, and oral health education, which also was given to hospital staff members. Findings showed a slight increase in the DMF rate, a minor improvement in oral hygiene, and a significant reduction in periodontal treatment needs. The results showed that without cooperation of the staff members, a dental education program would not succeed in this setting.