Indicación del Test Genético Preimplantacional en el Hospital Universitario de Canarias / Indication of Preimplantation Genetic Testing at the Hospital Universitario de Canarias

INTRODUCCIÓN: El test genético preimplantacional (PGT), es el análisis genético del embrión para determinar si es portador de alguna alteración genética o cromosómica. Los objetivos del presente trabajo son determinar las indicaciones de PGT de las parejas atendidas en el Hospital Universitario de Canarias (HUC), analizar su edad, procedencia, antecedentes médico-quirúrgicos y obstétrico-ginecológicos y/o andrológicos, así como valorar la posible existencia de factores de esterilidad, y relacionar la patología genética con procedencia de las pacientes. Además, con el objetivo de estudiar los porcentajes de gestación y efectuar una correlación entre las variables anteriormente descritas con la gestación. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio descriptivo y retrospectivo de todos los pacientes con la indicación de PGT de la Unidad de Reproducción del Hospital Universitario de Canarias, desde el año 2008 al 2018, con un total de 88 parejas/ 176 pacientes analizados. RESULTADOS: La edad media fue de 33,10 ± 3,79 años en mujeres y 35,36±4,59 en varones. El 54,5 % de las pacientes presentaron algún antecedente médico y el 37,5 % quirúrgico, en tanto que el 38,6 % de las mujeres y 58 % de los varónes tenían algún factor de esterilidad y, además, el 50 % referían una gestación previa. El 22 % de las mujeres y el 16 % de los varones presentaron un cariotipo patológico mientras que el estudio genético se llevó a cabo en el 40 % de las mujeres (97,5% patológico) y en el 36,4 % de los varones (95,5 % patológico). En la distribución de las pacientes por islas y edades, encontramos que la población observada y la esperada es prácticamente igual. Tras el PGT el 53 % de las pacientes consiguióuna gestación. CONCLUSIÓN: Las parejas de nuestro estudio obtuvieron una tasa de gestación del 53 %, similar al Registro SEF (46,8 %). Éstas son superiores con PGT frente al ICSI convencional, pues incrementa las posibilidades de lograr un embarazo al asegurar la transferencia sólo de embriones euploides. Debido a los factores de esterilidad hallados estaría indicado realizar su estudio previo al PGT y, dado sus buenos resultados, estimamos que se debe implementar esta técnica en los hospitales de referencia para FIV/ICSI

SUMMARY: Preimplantational genetic testing (PGT) is the genetic analysis performed on the embryo in early stages of development, to determine if any genetic or chromosomal alteration is carried. MATERIAL AND METHODS: A descriptive and retrospective study was carried out of all patients with the indication of PGT from the Reproduction Unit of the Hospital Universitario de Canarias, from 2008 to 2018, with a total of 88 couples/ 176 patients analysed. RESULTS: The average age was 33,0 ±3.79 years for women and 35,36 ± 4.59 years for males. 54,5% of the patients presented some medical history, and 37,5% had previous surgery, 3,6% of women and 58% of men had some infertility factor, and in addition, 50% of the patients reported a pregnancy. 22% of women and 16% of males had a pathological karyotype while the genetic study was carried out in 40% of women, (97,5% was pathological) and in 36,4% of males (95,5% was pathological). Regarding the distribution of patients by islands and ages, we found that the observed and expected population is practically the same. After PGT, 53% of the patients achieved a pregnancy. CONCLUSIONS: The couples in our study achieved a pregnancy rate of 53%, close to SEF Registry (46,8%). PGT pregnancy rates are higher than conventional ICSI and increases the chances of achieving a pregnancy by ensuring the transfer only of euploid embryos. Due to founded infertility factors, it would be indicated to perform infertility study in all couples that are going to undergo PGT. And, given the good results of the PGT, we estimate that this technique should be implemented in our Hospital

Longitudinal vocabulary development in Australian urban Aboriginal children: Protective and risk factors.

BACKGROUND: Vocabulary is a key component of language that can impact on children's future literacy and communication. The gap between Australian Aboriginal and non-Aboriginal children's reading and academic outcomes is well reported and similar to Indigenous/non-Indigenous gaps in other nations. Determining factors that influence vocabulary acquisition over time and may be responsive to treatment is important for improving Aboriginal children's communication and academic outcomes. AIM: To determine what factors influence Australian urban Aboriginal children's receptive vocabulary acquisition and whether any of these are risks or protective for vocabulary development. METHOD: One hundred thirteen Aboriginal children in South Western Sydney from the longitudinal birth cohort Gudaga study were assessed on The Peabody Picture Vocabulary Test multiple times: 3 years, just prior to school entry, at the end of the first and second years of formal schooling. Multilevel models were used to determine the effects of 13 fixed and manipulable maternal, child, and family variables drawn from previous research. RESULTS: Higher maternal education was found to be protective at 3 years and over time. The number of children in urban Australian Aboriginal households made an impact on vocabulary development and this varied over time. From 3 to 6 years, those with early poor non-verbal cognitive skills had vocabulary skills that remained below those with stronger non-verbal skills at 3 years. Girls exhibit an earlier advantage in vocabulary acquisition, but this difference is not sustained after 4 years of age. CONCLUSIONS: The risk and protective factors for vocabulary development in Australian Aboriginal children are similar to those identified in other studies with some variation related to the number of children in the home. In this limited set of predictors, maternal education, gender, non-verbal cognitive skills, and the number of children in households were all shown to impact on the acquisition of vocabulary to 3 years and or the developmental trajectory over time.

ENsCOPE: Scoping the Practice of Enrolled Nurses in an Australian Community Health Setting.

INTRODUCTION: A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice. AIM: To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting. METHODS: A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills. RESULTS: Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; 'Patient Education' and 'Clinical Observation'. Registered nurses identified some specialized skills-catheter and gastrostomy care-that could be undertaken by enrolled nurses with further education. CONCLUSION: We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.

Alternate scoring of the Bayley-III improves prediction of performance on Griffiths Mental Development Scales before school entry in preschoolers with developmental concerns.

BACKGROUND: The Bayley-III is widely used as an assessment tool in young children; however, its standard composite scores appear to under-estimate delay, severe and profound delay cannot be identified, and the lack of an overall score makes it difficult to compare results with later assessments. AIMS: To explore the use of Bayley-III quotient subtest and average scores, compared with composite subtest and average scores for both clinical and research purposes, comparing their ability to predict performance on the Griffiths Mental Development Scales (Griffiths) before school entry. METHOD: One hundred preschoolers referred for a diagnosis were assessed on the Bayley-III before 3.5 years. They were reassessed before school entry on the Griffiths. Composite and quotient scores were calculated and their ability to predict outcome compared across the score range. RESULTS: Averaging the three subscale quotient scores (Bayley-AQS) gave a similar mean score for this sample (61.1, SD 16.2) as for the Griffiths general quotient (Griffiths-GQ) (61.1, SD 19.6). The average composite scores (Bayley-ACS) had a significantly higher mean (74.2, SD 12.1). Correlations between the average scores on the Bayley-III and the Griffiths-GQ (0.8) were at least as strong as any of the individual subscale scores. Kappa coefficients showed that Bayley-AQS was superior to Bayley-ACS for predicting moderate and severe delay. Average change in scores was -0.1 for Bayley-AQS, and -13.2 for Bayley-ACS. Improvement in category of delay was seen in 28% of children using Bayley-AQS, and deterioration in 22%. In contrast, 5% improvement was seen using Bayley-ACS, and 65% deterioration. CONCLUSIONS: The three directly assessed subscales of the Bayley-III can be averaged to give an overall score. Bayley-AQS are a better measure of development in young children with delay than Bayley-ACS, and most children maintain their developmental classification using this method of scoring when re-assessed before school entry.

The radiological report... and then what?

The radiology report has always been considered as "the most important step in the clinical radiological act". While agreeing with this concept, the author emphasises that the report can in no way replace the duty to communicate with the patient, as mentioned in Art. 31, Italian Code of Medical Ethics. Italy aside, this issue has been thoroughly investigated and debated abroad since the 1970s and, in the past as well as more recently, many interesting contributions have been published both on the need for verbal communication, particularly in certain settings, and on the best manner to approach this task. A recent book published in Italy also provides useful advice in this regard. The author hopes that in Italy, as in other countries, an extensive debate will give rise to a fuller awareness of the issue, thereby providing a range of shared solutions.

Maternal and Infant Services: examination of access in a culturally diverse community.

OBJECTIVES: The aim of this study was to evaluate access of resident immigrant families from a non-English speaking background to Maternal and Infant Services operated by Community Health Services in south-western Sydney. METHODS: An ecological study compared the demographic characteristics of mothers with an infant aged less than 12 months in three separate data collections. These were a 3-month Community-based Health Services Census, the 1996 Midwives Data Collection and the ABS 1996 Census of Population and Housing. RESULTS: Information was collected from 2048 infants and their families who were newly registered with Maternal and Infant Services. Approximately 75% of newborn infants were registered with services. Women who were born in a non-English-speaking country were over-represented in the data. For both overseas and Australian-born women those who left school aged less than 17 years were under-represented compared with analysis of the related data systems. CONCLUSIONS: The data suggest that migrant women from non-English-speaking backgrounds are accessing Maternal and Infant Services. However, innovative approaches for service delivery are indicated for women who may be considered socially disadvantaged, irrespective of their ethnic or cultural backgrounds.

Management of children after presenting to hospital with acute asthma but not requiring admission.

OBJECTIVE: To examine the treatment of asthma in children aged 4-15 years in the 12 months following presentation to hospital with acute asthma but not requiring admission. METHOD: Questionnaire based survey addressing the child's use of health services, contact with general practitioners before presentation, use of asthma management plans, symptom frequency, and management of asthma. RESULTS: Sixty-six parents (response rate 50%) completed questionnaires. Children usually experienced infrequent episodic symptoms of asthma, and had good or excellent health (68%). Twenty-two children reported no medical follow up post-emergency department (ED). Of the 39 children who had been reviewed by their GP post-ED, 51% (n = 20) recalled discussing the reasons for presentation to ED with the GP, 41% (n = 16) had a lung function measurement and 64% (n = 25) had discussed ways to better manage the child's asthma to avoid the need for future ED attendance. Most parents of children with asthma (n = 57, 86%) recalled the GP explaining how to manage their child's asthma, but only 35 (61.4%) recalled the GP ever writing down these instructions. CONCLUSION: Children with acute asthma who do not require admission may be better managed in the community if there is greater recourse to GP care, use of written management guidelines and opportunities for additional community care are taken up. Further work is needed to identify strategies that will enable GPs to do this.

Evaluating the introduction of the enhanced primary care 75+ annual health assessments.

AIM: The study aimed to evaluate what effect the introduction of the enhanced primary care (EPC) health assessments has on the management of elderly patients. METHOD: The study was conducted across five Divisions of General Practice in South West Sydney. Twenty-one general practitioners participated in the study following response to an initial faxed questionnaire survey. An audit of patients' health assessments in conjunction with their records was conducted between June and August 2000. RESULTS: There were significant increase in the documentation of nonmedical problems and of patients' immunisation status. However, there was no increase in plans to refer patients to psychologists, mental health teams or social workers. Also no assessments resulted in a case conference and very few in a care plan. DISCUSSION: Health assessments are unlikely to improve clinical outcomes if they do not result in multidisciplinary care, including care plans, for patients with psychosocial and functional needs. CONCLUSION: Support strategies need to be implemented which assist general practitioners' management of psychosocial and functional problems.

Factors associated with frequent admission to hospital for patients with chronic airflow limitation.

BACKGROUND: Chronic airflow limitation (CAL) is a common cause of admission and readmission to hospital. This study has explored associated factors with repeat hospital admission in patients with CAL. METHOD: A retrospective file review of patients admitted more than once to hospital during the 1999 calendar year, with a diagnosis of CAL. RESULTS: Two hundred and two patients admitted with CAL accounted for 284 admissions and 1815 bed days. Of these, 46 patients were admitted more than once accounting for 115 (40.5%) admissions and 730 (39.8%) bed days. The study found evidence of general practice involvement in 35 (30.5%) admissions immediately before presentation at the hospital emergency department (ED). The discharge summary following that admission revealed only 67 (54%) were referred back to their general practitioners for follow up. The number of admissions attending the ED between the hours of 9.00 am and 5.00 pm were 62 (53.9%) and 96 (83.5%) between the hours of 7.00 am and 10.00 pm. CONCLUSION: Treatments given in hospital were similar, in most cases, to what could be provided at home with appropriate community based support. General practitioners were involved in approximately one-third of those patients requiring admission or re-admission to hospital.

Evaluating general practitioners' views about the implementation of the Enhanced Primary Care Medicare items.

OBJECTIVE: To investigate the issues for general practitioners surrounding the implementation of the Enhanced Primary Care (EPC) Medicare items for health assessments, care planning and case conferencing. DESIGN: Qualitative study of GPs' responses to a semistructured face-to-face interview. PARTICIPANTS AND SETTING: 30 GPs in the South Western Sydney Area. MAIN OUTCOME MEASURES: GPs' perceptions regarding barriers to coordination of care; use of the EPC items; difficulties with implementation; suggestions for improving EPC implementation; and coordination of care in general practice. RESULTS: Five main categories of response were identified to each area of questioning: time, organisation, communication, education, and resources. GPs expressed difficulties incorporating use of the items into their daily practice without support. CONCLUSIONS: Implementation of the EPC items not only facilitates integration between GPs and other healthcare professionals, it also depends upon other forms of integration to succeed. A facilitator and a structured framework to address issues are required to assist their implementation.

Changing approaches to asthma management in Australia: effects on asthma morbidity.

Asthma is an important public health issue in Australia and is responsible for significant morbidity and mortality in the community. Recognition of the impact of asthma on the health of Australians, and the apparent failure of new medications to reduce mortality and hospital admission rates resulted in a major review by the stakeholders in asthma care. This led to new approaches to asthma management based on strategic use of asthma medications and the development of the Asthma Management Plan (AMP). The AMP drew together current understanding of asthma to develop a simple stepwise approach to management that could be readily applied in patient management. The National Asthma Campaign (NAC), a coalition of the major stakeholders in asthma care, was launched in 1990 to lead the dissemination of the AMP. In association with other organisations interested in asthma care in Australia, the NAC has developed the AMP, and co-ordinated a decade of education and advocacy about asthma that targeted doctors, health professionals and the general public. These activities have been successful in raising awareness about asthma in the community. However, recent research, while demonstrating the continued uptake of written asthma action plans for asthma and decrease in use of inhaled bronchodilator medications, reported a decrease in use of preventive therapy by people with asthma. These activities have had a sustained impact on asthma-related health outcomes with mortality at the lowest level since 1960 and a decline in hospital readmission rates. This is useful information because there is sound evidence that the prevalence and possibly severity of asthma in children has increased. However, review of management in primary care and among people who present to emergency services with acute asthma suggest that many people continue to manage their asthma poorly. Continued education is needed to build on the progress that has been made. There are opportunities to do this through efforts to integrate general practitioners into the wider health system through the formation of Divisions of General Practice. Recognition of asthma as a health priority area at a national level will help to enhance and maintain awareness of the public health importance of asthma and facilitate the further development of the initiatives begun during the last decade or more.

Implementation of the enhanced primary care items requires ongoing education and evaluation.

OBJECTIVE: The study aimed to evaluate the uptake and usage of the Federal Government's Enhanced Primary Care (EPC) items by general practitioners in outer urban general practice. METHOD: Faxed questionnaire with telephone follow up of a random sample of 347 GPs in South West Sydney, in March and April 2000. RESULTS: There was a response rate of 70.6%. Seventy-three percent of respondents reported they had heard of the EPC package and 27% of all the respondents had used one or more of the items. Twenty-three percent had claimed for health assessments (median number 3), 4.5% for care plans (median number 3) and 4% for case conferences (median number 1). Just under half of the GPs who had claimed for health assessments had conducted them in the patient's home. Most GPs either had no system for the use of the items or planned to use them opportunistically. Forty-nine percent of GPs had an age-sex register and those who did were more likely to have claimed for an EPC item and to have specific plans for their use. CONCLUSION: While most GPs had heard of the EPC items, only a minority had used them and few planned to use them systematically within their practice. There is a need to address barriers to the uptake of the EPC items and to provide greater support to GPs and health professionals involved with their implementation, especially for care plans and case conferences. Evaluation of the EPC items needs to be an integral part of the implementation process.

Agreement in symptoms of anxiety and depression between patients and GPs: the influence of ethnicity.

BACKGROUND: Few studies have focused specifically on the role of ethnicity in the identification and treatment of anxiety and depressive symptoms among patients consulting GPs. METHODS: A survey was conducted of 4753 patients aged 18-90 years attending general practices in Sydney, Australia. Three methods of case detection were used: a GHQ-12 score (> or = 3), self-report symptoms (using a checklist) and GP detection of symptoms. Four regional groupings based on country of birth [other English speaking countries (ESB), European, Asian (predominantly south east Asian) and other non-English speaking (other NESB)] were compared with Australian (AB) patients. RESULTS: Compared with AB patients, Asian patients had a lower mean GHQ-12 score (2.04 versus 2.54) and a lower rate of GP detection (10.4% versus 20.5%) but they recorded a similar rate of self-report symptoms (16.7% versus 20.1%). For Asian patients, 24.6% of all cases identified by self-report or by GP detection were identified by both methods, compared with 44% for AB patients. Similar patterns of treatment and referral were observed for detected cases. Compared with AB patients, Asian and other NESB patients were more likely to desire more time to discuss their problems with their GP (18.5% versus 42.0%, 37.3%) and receive an explanation of medications prescribed (18.9% versus 46%, 40.0%). CONCLUSION: These results suggest that there are substantial variations in the rates of detection of anxiety and depressive symptoms in GP patients depending on the screening methods used and the broad ethnic background of patients. Such symptoms may be under-diagnosed in Asian patients in particular.

Differences in body composition between Tongans and Australians: time to rethink the healthy weight ranges?

OBJECTIVE: The prevalence of obesity varies considerably between countries when compared using the common international standard. This study investigated body size and body composition in Tongan and Australian Caucasian adults. DESIGN: Cross-sectional comparative study. SUBJECTS: A total of 543 Tongans and 393 Australians. MEASUREMENTS: Weight, height, waist and hip circumference, four skinfolds, midarm circumference, elbow breadth, and body composition by bioelectrical impedance using sex- and ethnic-specific regression equations. RESULTS: Tongan women (mean body mass index (BMI)+/-s.e.=32.6+/-0.4 kg/m2) were larger than Australian women (BMI=25.8+/-0.4 kg/m2), with more fat-free mass (FFM; 52.2+/-0.4; 42.6+/-0.3 kg), fat mass (37.1+/-0.7; 26.6+/-0.8 kg) and percentage body fat (%fat) (40.5+/-0.4; 37.0+/-0.5%), respectively. Tongan men also had higher BMI (Tongan= 30.3+/-0.3 kg/m2; Australian=26.5+/-0.3 kg/m2), FFM (70.2+/-0.5; 62.3+/-0.6 kg) and fat mass (23.5+/-0.6; 20.7+/-0.7 kg). When compared with Australians within the same BMI range, Tongans had significantly higher FFM, elbow width, midarm muscle area and significantly lower %fat. The %fat at BMIs of 25 and 30 kg/m2 in Australian women was equivalent to the %fat found in Tongan women at 28.8 and 35.1 kg/m2, respectively. BMIs of 25 and 30 kg/m2 in Australian men corresponded with 27.5 and 35.8 kg/m2 in Tongan men. Skinfold thicknesses, waist, hip and WHR measurements suggested differences in fat distribution and body shape between ethnic groups, particularly in women. CONCLUSION: These results suggest that the standard healthy weight ranges recommended for international use may not be appropriate standards for use in the Tongan population.

Asthma is more prevalent in rural New South Wales than metropolitan Victoria, Australia.

OBJECTIVE: The aim of this study was to compare the prevalence of adult respiratory symptoms and conditions in a rural setting with a metropolitan setting. METHODOLOGY: We used cross-sectional population surveys of respiratory health using the European Respiratory Health Survey screening questionnaire. A random sample of 4455 eligible young adults aged 20-44 years, from electoral rolls in south-eastern metropolitan Melbourne, Victoria, and 4521 from rural south-western New South Wales were surveyed. RESULTS: Response rates of 72% (n=3194) and 69% (n=3121) were achieved in Melbourne and the Riverina, respectively. Respondents from the Riverina reported significantly higher prevalences of nocturnal dyspnoea (P<0.01), chronic bronchitis (P=0.03), an asthma attack in the previous 12 months (P<0.001), ever having had asthma (P<0.001) and doctor-diagnosed asthma (P<0.001) compared to those from Melbourne. However, among those with 'asthma attacks in the last 12 months', Melbourne respondents experienced a higher frequency of attacks (P<0.05). Riverina respondents reported a higher prevalence of smoking (P<0.05) and smoked more cigarettes on average (P<0.001) than Melbourne respondents. However, annoyance from air pollution was higher in Melbourne than in the Riverina. CONCLUSIONS: These results suggest that asthma is more prevalent in rural southern New South Wales than in Melbourne but follows a different pattern of exacerbations.

Where's the common ground? A survey of hospitals, community health centres and divisions of general practice in Australia.

BACKGROUND: Divisions of general practice are key structures for integration between general practice and other health services in Australia. AIM: To compare the views of divisions of general practice toward integration of care with those of hospitals and community health services. METHOD: Representative national samples of public hospitals and community health centres (CHCs) and a census of divisions of general practice (DGP) were surveyed on their current collaborations and links as well as barriers to and factors that enhance integration between general practitioners and other health services. RESULTS: There is wide agreement on the need for greater integration. Personal links (via letter, phone and face to face) were thought to be useful. However, general practice liaison officers were seen as especially useful. All organizations rated different accountabilities and responsibilities as a highly significant barrier. Resources, structures for collaboration and high level organisational support were rated as being more useful in enabling greater integration. CONCLUSION: Formalizing collaboration will require changes to funding and accountability. However there is also a need for cultural change to support greater integration of patient care between general practice and both hospitals and community health services.

Prevalence, detection and management of anxiety and depressive symptoms in unemployed patients attending general practitioners.

INTRODUCTION: This study examined the detection and management of anxiety and depressive symptoms among unemployed patients attending general practitioners (GPs). METHOD: A cross-sectional study was undertaken of anxiety and depressive symptoms in general practice using measures completed by patients and GPs. Eligible patients were adults aged 18 to 64 years either working (n = 2273) or unemployed (n = 392). RESULTS: Eighty per cent of patients were attending their regular GP at the time of the study. Unemployed patients were found to have a higher mean general health questionnaire (GHQ-12) score than employed patients (3.8 compared with 2.4, p < 0.001); were more likely to report symptoms of anxiety and depression which required medical treatment during the previous 4weeks (30.9% compared with 14.6%, p < 0.001); and were more likely to have been treated for anxiety and depression by the GP (27.8% compared with 15.7%, p < 0.001). Among patients who the GPs reported treating for anxiety and depression, unemployed patients were 3.3 times (95% CI: 2.0-5.4) more likely to be prescribed medication than employed patients when severity was controlled but were no more likely to be referred to other health services. Unemployed patients identified increased use of services and were less satisfied with the care that they had received. CONCLUSIONS: Unemployed patients attending GPs have an increased risk of anxiety and depressive symptoms. Increased prescription of medication as opposed to referral suggests that GPs may treat their unemployed patients differently to employed patients. GPs need to be aware of the higher risk and severity of anxiety and depressive symptoms among unemployed patients and their desire to be more actively involved in their treatment. General practice is an important setting for addressing the health needs of unemployed people.

Perception of body size in the Tongan community: differences from and similarities to an Australian sample.

OBJECTIVE: The prevalence of obesity in Tonga is high and increasing. Attempts to address this major health issue would be assisted by a realistic concept of current and preferred body sizes. In this study, body size perception in Tongans was compared with that of Australians. DESIGN: Cross-sectional comparative study. SUBJECTS: 542 Tongans, 89 of whom were enrolled in a weight-loss programme (WLP); 481 Australians. MEASUREMENTS: Subjects were weighed and measured. Two series of photographs (one female, one male), representing specific body mass indexes (BMIs) were used to assess body perception. RESULTS: The BMIs of the Tongans were higher than those of the Australians (Tongans: female 32.6+/-0.35 (mean +/- s.e.m); male, 30.4+/-0.33; Australians: female, 25.6+/-0.33; male 26.3+/-0.26 kg/m2). Tongan women underestimated their body size; Tongan men and Australians overestimated. WLP and younger Tongan women preferred smaller body sizes for themselves and for men and women in general. There were gender differences in preferred healthy and attractive female sizes (men: 27 kg/m2; non-WLP women: 25 kg/m2; WLP women: 23 kg/m2) and male sizes (men: 29-30 kg/m2; women: 26-27 kg/m2 chosen by Tongans. Preferred, attractive and healthy body sizes chosen by Australian men and women were similar; about 24 kg/m2 for males and 21-22 kg/m2 for females. CONCLUSION: Tongans preferred larger body sizes than did Australians, particularly the men, but WLP women's preferences were similar to those of Australians. There is evidence that preferences are changing in Tonga with time, and probably with increasing Western influence.

Asthma mortality in Australia 1920-94: age, period, and cohort effects.

STUDY OBJECTIVE: To investigate asthma mortality during 1920-94 in Australia in order to assess the relative role of period and birth cohort effects. DESIGN: Asthma mortality (both sexes) was age standardised and examined for changes over time. The data were also examined for age, period, and cohort (APC) effects using Poisson regression modelling. SETTING: National Australian mortality data. PARTICIPANTS: Population (both sexes) aged 15-34 years, 1920-94. MAIN RESULTS: Age adjusted period rates indicate an increase in asthma mortality during the 1950's, and increases and subsequent falls (epidemics) during the mid 1960s and late 1980s. APC modelling suggested an increasing cohort effect (adjusted for both age and period) from the birth cohort 1950-54 onwards. Period effects (adjusted for age and cohort) are characterized by an increase in the 1950s (possibly due to changes in diagnostic labelling), minimal or no increases in the mid 1960s and late 1980s (where period peaks had been noted when data were adjusted for age only), and declines in mortality risk subsequent to the periods where age-period analysis had noted increases. Thus, in Australia, some of the mid 1960s epidemic in asthma deaths, and all of the late 1980s mortality increase, seem to be attributable to cohort effects. CONCLUSIONS: The increase in asthma mortality cohort effect is consistent with empirical evidence of recent increases in prevalence (and presumably incidence) of asthma in Australia, and suggests the need for more research into the underlying environmental aetiology of this condition.