A randomised controlled trial using mobile advertising to promote safer sex and sun safety to young people.

Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the use of mobile advertising for health promotion. Mobile advertising subscribers aged 16-29 years residing in Victoria, Australia (n = 7606) were randomised to the 'sex' or 'sun' group and received eight messages during the 2008-2009 summer period. Changes in sex- and sun-related knowledge and behaviour were measured by questionnaires completed on mobile phones. At follow-up, the sex group had significantly higher sexual health knowledge and fewer sexual partners than the sun group. The sun group had no change in hat-wearing frequency compared with a significant decline in hat-wearing frequency in the sex group. This is the first study of mobile advertising for health promotion, which can successfully reach most young people. Challenges experienced with project implementation and evaluation should be considered as new technological approaches to health promotion continue to be expanded.

Public reaction to the portrayal of the tobacco industry in the film The Insider.

OBJECTIVES: To assess public perceptions of the tobacco industry and behavioural intentions for tobacco use in response to watching the film The Insider. DESIGN: Self administered pre-film survey conducted immediately before viewing and post-film telephone survey conducted within 1-5 weeks of viewing. SETTING: Two commercial cinemas in Melbourne, Australia. SUBJECTS: 323 cinema patrons were recruited before screening of target films. 182 watched The Insider, 141 watched Erin Brockovich. INTERVENTIONS: Subjects watched one of two films: The Insider which featured information about unethical conduct by the tobacco industry and negative information about the health effects of smoking, or the "control" film Erin Brockovich which had an analogous plot without anti-tobacco content. MAIN OUTCOME MEASURES: Pre-film questionnaire: assessed movie viewing habits, demographic characteristics, smoking status, attitudes towards the tobacco industry, intentions for smoking. Post-film questionnaire: assessed same attitudes and intentions plus questions on the film viewed and perceptions of smoking prevalence. RESULTS: 266 (82%) subjects completed the post-film survey. Attitudes toward the tobacco industry were unfavourable at baseline. Those who saw The Insider held more negative views of business conduct by the tobacco industry than those who saw Erin Brockovich, once pre-existing attitudes to the industry were controlled for. The Insider also appears to have promoted a short term reduction in intentions to smoke. CONCLUSIONS: Results of this study suggest that if people were recurrently exposed to anti-tobacco content in movies there is potential for a more substantial and lasting impact on attitudes toward the tobacco industry and smoking.

Trends in sun protection behaviour among Australian young adults.

OBJECTIVE: To study changes in sun protection behaviour, exposure and sunburn that occur from late adolescence to young adulthood. METHOD: A longitudinal design was used to survey a cohort on their sun-protection behaviour from the middle of their final year at school to more than three years after finishing school. RESULTS: Males reported higher exposure, less use of sunscreen and deeper tans than females. Yet males wore hats more frequently. People with skin that just burnt were more likely to protect themselves from the sun than people with skin that tanned. Longitudinally, the level of reported exposure and the depth of tan declined, frequency of covering up, hat wearing and sunscreen use remained unchanged, and a slight U-shaped trend was observed for sunburn. CONCLUSIONS: Young adulthood may be an important time where deteriorating trends for sun protection found in the teen years are averted. Males are at greater risk of sun exposure than females. IMPLICATIONS: It is recommended that health promotion programs capitalise on the trend of improved sun-protective behaviours during the transition from adolescence to young adulthood, with a particular focus on young men.

Data management in schistosomiasis control programmes.

Adequate data recording, processing, analysis and evaluation are all components of data management within schistosomiasis control programmes oriented towards reduction of morbidity. Without data management, the response to operational questions will remain subjective and vague. Different types of data related to the population and the environment are reviewed. Examples of data format and presentation are given. The importance of data management for proper short and long term evaluation of control measures is emphasized.

Dose-finding trial using Oltipraz to treat schoolchildren infected with Schistosoma mansoni in Gezira, Sudan.

A field trial has been carried out in Sudan to determine the optimum dosage regimen for the use of Oltipraz in the treatment of Schistosoma mansoni in schoolchildren. A total of 294 children were treated in six groups to test 15 mg/kg, 20 mg/kg, and 25 mg/kg, using a single oral dose and a divided dose taken some 6 h apart. The children were interviewed before and then 24 h after treatment to determine the prevalence of drug-induced side-effects. Most of the children having complained of abdominal pain before treatment, insisted that they suffered further abdominal pain as a result of the drug. Four children complained of fingertip pain and 17 of blurred vision. The latter side-effect had not previously been recorded in Sudan and, with the fingertip pain, is a cause for concern. There was no difference in the cumulative failure rates between the single and the divided doses, but there was a significant improvement in the efficacy from the 15 mg/kg to the higher doses. The cumulative failure rate increased with higher pretreatment egg count. However at each level the reduction in egg count among failures at the 5-week follow-up, was significant at the 95% probability level. The efficacy of the drug was satisfactory when used at 20 or 25 mg/kg, but the strange side-effects need to be explained before any further use can be recommended.

Treatment with praziquantel of schoolchildren with concurrent Schistosoma mansoni and S. haematobium infections in Gezira, Sudan.

A field trial was conducted in Sudan to evaluate the acceptability and efficacy of praziquantel given to schoolchildren aged 7-11 years who were all infected with both Schistosoma mansoni and S. haematobium. Two dosage regimes were compared, a single dose of 40 mg/kg bodyweight, and a divided dose 2 X 20 mg/kg given 4-6 h apart. When interviewed 24 h after treatment, 80% of the children complained of drug-induced abdominal pain, diarrhoea, nausea or vomiting. However none of the side-effects persisted beyond the day of treatment. More children complained of side-effects from the divided dose than from the single dose. The cure rate in the divided-dose group was slightly better than in the single-dose group but the differences were not significant at any follow-up, nor when results were expressed in terms of cumulative failures. The initial cure rates were 66.3% and 61.8% at 1 month, and 73.2% and 64.7% at 3 months for the divided and single doses respectively. After 12 months there had apparently been considerable reinfection with S. mansoni and 73% of the children were passing eggs. Reinfection with S. haematobium was negligible.

A field trial using praziquantel (BiltricideR) to treat Schistosoma mansoni and Schistosoma haematobium infection in Gezira, Sudan.

A field trial was conducted in the Gezira, Sudan, to evaluate the acceptability and efficacy of praziquantel, a new schistosomicide. In one Arab village 350 patients with Schistosoma mansoni were randomly assigned to two treatment groups and given 1 X 40 mg kg-1 (Group A) or 2 X 20 mg kg-1 given four to six hours apart (Group B). In two small settlements (camps) 2 km distant from the Arab village 38 patients with S. mansoni and 43 with concurrent S. mansoni and S. haematobium infections were given 1 X 40 mg kg-1. Side effects were mild and limited to the first 24 hours after treatment. The main complaints were abdominal pain, diarrhoea, urticaria and/or vomiting and were most common in the camp residents (79%) with 60% of Group A and 45% of Group B having one or more side effects. One month after treatment 'cure' rates were: Camps 63%, Group A 84% and Group B 96%, and the reduction in egg output was over 95%. After 12 months re-infection was greater in the camps. As there was no significant difference in the egg output reduction between the two treatment regimes, praziquantel is recommended for mass chemotherapy in Gezira at the logistically simpler regimen of 1 X 40 mg kg-1.

Diabetic twin pregnancy: an unequal result.

A diabetic mother produced twins dissimilar in both appearance and blood biochemistry--one being clearly macrosomic and "hyperinsulinised" at delivery, the other apparently normal. It is suggested that the development of fetal hyperinsulinism may depend not only on maternal blood-glucose control but also on fetal blood-supply or genetic factors.

Simplified management of pregnancy complicated by diabetes.

Simple methods for the management of pregnancy complicated by diabetes are described. Emphasis was placed on keeping patients out of hospital, good control of diabetes and vaginal delivery at 38 weeks: using these methods, there were nine perinatal deaths in a consecutive series of 101 pregnancies complicated by diabetes. Four of the perinatal deaths were due to the respiratory distress syndrome. The patients whose diabetes was diagnosed during pregnancy had significantly heavier babies (18 pregnancies, mean birth weight 3337 g) than the established diabetics (83 pregnancies, mean weight 3011 g) despite significantly lower fasting blood glucose levels in the former and similar mean gestational ages at delivery. Mean fasting blood glucose levels for the whole series during the first, second and third trimesters were 9.0, 6.7 and 5.6 mmol/l respectively. The mean duration of antenatal stay in hospital for complications related to diabetes was 29 days. Diabetic retinopathy did not seem to be adversely affected by pregnancy.

Fetal growth retardation and the arteries of the placental bed.

The morphology of the placental bed spiral arteries was studied in 68 pregnancies complicated by fetal growth retardation and in 40 pregnancies with a normally grown fetus. When the birth weight was normal the extent and depth of physiological vascular changes were normal except in those pregnancies complicated by pre-eclampsia. When the birth weight was low and the mothers were normotensive the extent and depth of physiological vascular changes were either normal or restricted, and in all patients with hypertension and a baby with low birth weight the physiological changes were restricted to the decidual segments of the spiral (uteroplacental) arteries. Acute atherosis was only found in pregnancies complicated by hypertension, particularly if there was proteinuria. We do not believe that there exists an arteriopathy which is common to hypertensive and normotensive pregnancies complicated by fetal growth retardation.

Letter: Prostaglandins and induction of labour.

PIP: In response to a recent editorial advocating use of prostaglandins (PGs) for preterm labor induction in women with essential and renal hypertension, preeclampsia, growth-retarded fetuses, diabetes, and rhesus incompatibility, this letter questions the logic of such a recommendation. Given that PGF2 alpha has been shown to have a vasconstrictive effect on placental veins and on umbilical arteries; that hypertensive states in pregnancy may cause pathological lesions in uteroplacental arteries; and that preeclampsia involves an inadequate response of the uteroplacental arteries to placentation; PG induction of labor may exacerbate the conditions of complicated pregnancy which necessitated labor induction in the first place. Use of PGs for premature induction of labor in pregnancies by hypertensive states, and perhaps in other conditions associated with intrauterine hypoxia, may aggravate fetal distresses. The letter suggests that in vitro biopsy studies of human pregnanted uterus need to be perform to investigate the action, if any, of PGs on myometrial blood vessels before PGs can be recommended for premature labor induction in cases of hypoxia and fetal distress.^ieng

Post-partum hypercalcaemia in treated hypoparathyroidism.

Two patients with post-thyroidectomy hypoparathyroidism were observed throughout three pregnancies. Their normal maintenance treatment with vitamin D remained unaltered. Serum calcium levels remained normal until shortly before delivery but rose rapidly in the immediate postpartum period to peak levels of 7.8, 6.0, and 6.8 mEq/l. while still on normal or reduced maintenance treatment. This apparent increased sensitivity to vitamin D after delivery persisted for as long as three months.

Management of pregnancy complicated by hypertrophic obstructive cardiomyopathy.

We report our experiences with nine women suffering from hypertrophic obstructive cardiomyopathy who between them had 13 pregnancies, 10 of which were directly managed by us. Though at first we felt that the theoretical hazards of vaginal delivery indicated elective caesarean section, experience has convinced us that in the absence of an obstetrical contraindication these patients may be delivered vaginally provided a betaadrenergic blocking drug is administered during pregnancy and especially during labour, ergometrine is given at the end of the second stage, adequate supplies of cross-matched blood are available, and prophylaxis against infective endocarditis is administered. We have found no evidence of any adverse effects of either propranolol or pronethalol on the foetus.