Socioeconomic correlates and trends in smoking in pregnancy in New South Wales, Australia.

OBJECTIVE: This study describes trends (1994-2007) in smoking in pregnancy (SIP) among an Australian population sample of women. This study also examines trends in the socioeconomic distribution of SIP over the 14-year period. METHODS: Bivariate and multiple logistic regression analyses of the NSW Midwives Data Collection were used to explore the associations and trends in SIP by sociodemographic factors. RESULTS: The prevalence of SIP in New South Wales (NSW) declined from 22.1% (1994) to 13.5% in 2007. However, the largest decrease in SIP rates was among the highest socioeconomic group (67.9% decline), and smaller declines were observed among teenage and remote rural mothers. Maternal age, ethnicity, Aboriginality, area of remoteness and socioeconomic status were independently associated with SIP. The distribution of NSW mothers has changed, with fewer younger mothers and more from an Asian background. CONCLUSION: This study reported large declines in SIP prevalence, with a population effect similar to that expected following exposure to (Cochrane-defined) intensive behavioural interventions. However, no specially targeted public health efforts were made during this period to influence SIP, so that social norm change is the likely explanation for these population health changes. The relative decline in SIP was smaller among low-socioeconomic status mothers, by language spoken at home, Aboriginality and area of remoteness, suggesting that inequalities in SIP have increased over this 14-year period. This information informs equity-based approaches to targeting further smoking cessation programs for pregnant Australian women.

Evaluación del ffecto modulador del factor de cecimiento similar a la insulinaa tipo i (igf-i) en linfocitos t de bazo de ratas sometidas a estrés nutricional / Evaluation of the modulating effect of type-i insulin-like growthfactor (igf-i) in rat spleen-t lymphocytes under nutritional stress / Avaliacáo doefeiito modulador do factor de cescimento similar a insulina tiipo i (igf-i) em linfócitos t de baço de ratos submetidos a stress nutricional

En este trabajo se estudió el papel del factor de crecimiento similar a la insulina tipo I (IGF-I) como factormodulador del estrés inducido por una restricción proteica en la dieta, en linfocitos T de bazo de rata. Se encontró que la restricción proteica disminuye el peso corporal en un 15%, el peso del bazo en un 32% y la población total de linfocitos T en un 42%. Igualmente, se observó en la población restringida un incremento en los porcentajes de las subpoblaciones T-CD4, T-CD8 y linfocitos B, y una relación T-CD4/T-CD8 disminuida, lo que sugiere una función inmune afectada por la malnutrición. También se halló que los cultivos de linfocitos provenientes de bazo de ratas en restricción proteica presentanmenor proliferación que los provenientes de ratas bien alimentadas; dicha proliferación se incrementa al adicionar IGF-I de manera dependiente de la dosis. Esta respuesta depende, también, del contenido de proteína en la dieta, observándose una mayor y más pronta respuesta a IGF-I en el grupo bien nutrido. La concanavalina A incrementó, igualmente, la proliferación en ambos grupos de animales, y al combinarla con IGF-I se presentó un sinergismo en la respuesta. En este trabajo se encontró, también, que la restricción proteica incrementa la apoptosis de los linfocitos T, y que la adición de IGF-I logra proteger dichas células de la apoptosis soportando el papel inmunomodulador de esta hormona en estrés nutricional.

In this work we studied the role of Insulin- like Growth Factor-I (IGF-I) as stress modulator in spleen T-lymphocytes from protein restricted rats. In protein restriction we found 15% lowered body weight, 32% lowered spleen weight and a reduction of 42% in total T-cell population. Also, increased percentages of T-CD4, T-CD8 and B cell populations and lowered T-CD4/T-CD8 ratio was observed, suggesting an impaired immune function due to malnutrition. Cultures of spleen T-lymphocytes from protein restricted rats showed less proliferation than the ones from well fed rats, this proliferation was increased after the addition of IGF-I in a dose depending manner. This answer depends, also, from the protein content of the diet, since the well fed animals showed a higher and faster answer. Concanavaline A, also, increased proliferation in both groups of rats and when combined with IGF-I a synergistic answer was found. In this work we also found that protein restriction increased apoptosis of T-lymphocytes, and the addition of IGF-I helped in the recovery of those cells supporting the immunomodulator role of IGF-I in nutritional stress.

Neste trabalho foi estudado o papel de Factor de Crescimento Similar à Insulina Tipo I (IGF-I) como factor modulador do stress induzido por uma restrição proteica em linfócitos T de baço de rato. Encontrou- se que a restrição proteica diminui o peso corporal em 15%, o peso do baço dos animais em 32% e a população total de linfócitos T em 42%. Igualmente, se observou uma alteração nas percentagens das subpopulações T-CD4, T-CD8 e linfócitos B, e uma relação T-CD4/T-CD8 diminuída que sugere uma função imune afectada pela má nutrição. Foi encontrado que os cultivos de linfócitos provenientes do baço de rato em restrição proteica apresentam menor proliferação que os provenientes de ratos bem alimentados; dita proliferação incrementa ao adicionar IGF-I de maneira dependente da dose. Esta resposta depende, também, do conteúdo de proteína na dieta, observando- se uma maior e mais rápida resposta a IGF-I no grupo bem nutrido. A concavalina A incrementou, igualmente, a proliferação em ambos grupos de animais, e ao combiná-la com IGF-I apresentou-se um sinergismo na resposta. Nesta investigação também foi encontrado que a restrição proteica incrementa a apoptose dos linfócitos T e que a adição de IGF-I permite proteger estas células da apoptose dando suporte ao papel imunomodulador desta hormona em stress nutricional.

Sexual health behaviours among Pacific Island youth in Vanuatu, Tonga and the Federated States of Micronesia.

ISSUES ADDRESSED: This study was conducted to describe the sexual risk behaviours of youth within the Pacific Island nations of Vanuatu, Tonga and the Federated States of Micronesia. METHODS: General health behaviour surveys were conducted with youth aged 15-19 years and not attending school in the three countries. A sample of 390 Ni-Vanuatu youth from the Shefa Province, 934 youth from three island provinces of Tonga and 92 youth from Pohnpei, the main island of the four island states of the Federated States of Micronesia, were interviewed in gender-specific groups. Questions were asked about sexual behaviours that may contribute to unintended pregnancy or sexually transmitted infections (STIs). RESULTS: Moderate to high percentages of youth were sexually active (had a least one sexual partner) in the Pacific island nations of Vanuatu (49.7%), Tonga (35.5%) and the Federated States of Micronesia (76.1%). Young men were more likely to engage in sexually risky behaviour than young women. They were more likely to be sexually active, have had multiple sexual partners and have had sex when drunk or high. Of those sexually active, more young men than women in Vanuatu (36.1% compared with 30.6%) and Micronesia (54.2% compared with 50%) never used protection against STIs. However, of the sexually active Tongan youth, the proportion of females (61.1%) who reported never using protection against STIs was nearly double the proportion reported by Tongan males (32.2%). CONCLUSION: A high percentage of young people not attending school in the Pacific island nations of Vanuatu, Tonga and the Federated States of Micronesia are at risk of unintended pregnancy and STIs, including HIV, because of patterns of sexual risk behaviour.

A comparison of the sports safety policies and practices of community sports clubs during training and competition in northern Sydney, Australia.

OBJECTIVES: To compare the safety policies and practices reported to be adopted during training and competition by community sports clubs in northern Sydney, Australia. METHODS: This cross sectional study involved face to face interviews, using an 81 item extensively validated questionnaire, with representatives of 163 community netball, rugby league, rugby union, and soccer clubs (response rate 85%). The study was undertaken during the winter sports season of 2000. Two separate 14 item scales were developed to analyse the level of safety policy adoption and safety practice implementation during training and competition. The statistical analysis comprised descriptive and inferential analysis stratified by sport. RESULTS: The reliability of the scales was good: Cronbach's alpha = 0.70 (competition scale) to 0.81 (training scale). Significant differences were found between the safety scores for training and competition for all clubs (mean difference 11.2; 95% confidence interval (CI) 10.0 to 12.5) and for each of the four sports: netball (mean difference 14.9; 95% CI 12.6 to 17.2); rugby league (mean difference 10.3; 95% CI 7.1 to 13.6); rugby union (mean difference 9.4; 95% CI 7.1 to 11.7); and soccer (mean difference 8.4; 95% CI 6.5 to 10.3). CONCLUSIONS: The differences in the mean competition and training safety scores were significant for all sports. This indicates that safety policies were less often adopted and practices less often implemented during training than during competition. As injuries do occur at training, and sports participants often spend considerably more time training than competing, sporting bodies should consider whether the safety policies and practices adopted and implemented at training are adequate.

The development of a tool to audit the safety policies and practices of community sports clubs.

Despite increased national effort directed at sports injury prevention in Australia since the mid 1990s, there is a lack of information available about the sports safety policies and practices of community sports clubs. The aim of this study was to develop a valid and reliable sports safety audit tool (SSAT) to identify these safety policies and practices. A literature review identified issues to be covered by the SSAT. Consultation with "experts" and piloting the SSAT with 19 community sports clubs in metropolitan Sydney established face and content validity. Test-retest reliability was assessed in six clubs. Inter-rater reliability was assessed using twenty-four independent representatives from eight clubs. Face and content validity studies identified issues to include in the SSAT and improvements to language and layout. Test-retest reliability was 91% (range 68-100%). Inter-rater reliability ranged from 40-65% when missing data and 'don't know' answers were included, and from 62-75% when only 'definitive' answers were included. Club presidents and secretaries provided more definitive information than other informants. A preliminary list of safety issues that clubs addressed well or poorly was identified. The SSAT is a useful tool for gathering baseline data, benchmarking and targeting sports safety interventions with community sports clubs. Club presidents and secretaries are the preferred contact point and a face-to-face interview is the best administration mode. A tool to identify safety policies and practices is now available for use by anyone supporting community sports clubs to improve safety.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home.

PURPOSE: To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia. METHODS: Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns. RESULTS: The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups. CONCLUSIONS: There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

Bullying behaviour and psychosocial health among school students in New South Wales, Australia: cross sectional survey.

OBJECTIVES: To examine the prevalence of bullying behaviours in schoolchildren and the association of bullying with psychological and psychosomatic health. DESIGN: Cross sectional survey. SETTING: Government and non-government schools in New South Wales, Australia. PARTICIPANTS: 3918 schoolchildren attending year 6 (mean age 11.88 years), year 8 (13.96), and year 10 (15.97) classes from 115 schools. MAIN OUTCOME MEASURES: Self reported bullying behaviours and psychological and psychosomatic symptoms. RESULTS: Almost a quarter of students (23.7%) bullied other students, 12.7% were bullied, 21.5% were both bullied and bullied others on one or more occasions in the last term of school, and 42.4% were neither bullied nor bullied others. More boys than girls reported bullying others and being victims of bullying. Bullying behaviour was associated with increased psychosomatic symptoms. Bullies tended to be unhappy with school; students who were bullied tended to like school and to feel alone. Students who both bullied and were bullied had the greatest number of psychological and psychosomatic symptoms. CONCLUSIONS: Being bullied seems to be widespread in schools in New South Wales and is associated with increased psychosomatic symptoms and poor mental health. Health practitioners evaluating students with common psychological and psychosomatic symptoms should consider bullying and the student's school environment as potential causes.

Substance use and socio-demographic factors among aboriginal and Torres Strait Islander school students in New South Wales.

OBJECTIVE: To estimate prevalence rates of substance use and associated socio-demographic factors among Aboriginal and Torres Strait Islander (ATSI) secondary students. METHOD: This paper presents ATSI data from population-based school surveys conducted in 1996, 1992 and 1989 in New South Wales and replicates identical analysis using the three datasets. RESULTS: The proportion of ATSI students in each survey ranged from 2.5% to 3.8%. After adjusting for age, gender and socio-demographic factors, ATSI students were more likely to smoke cigarettes, and to have tried cannabis and other illicit substances. CONCLUSIONS: This study suggests that Aboriginal and Torres Strait Islander students were more susceptible to, and maintained a higher rate of, substance use than non-Aboriginal and Torres Strait Islander youth. Socio-demographic differences between Aboriginal and non-Aboriginal students in age, rural/urban status, living with both parents, reporting poor school performance, low parental supervision and high school absenteeism remained significantly associated with Aboriginal status and substance use. IMPLICATIONS: This is one of the first studies examining substance use in a large and representative sample of in-school ATSI youth. These results provide information useful for public health advocates, and require policy changes more likely to reduce substance use among ATSI youth.

Asthma, health behaviors, social adjustment, and psychosomatic symptoms in adolescence.

The association of health behaviour, indicators of social adjustment, and psychosomatic symptoms with diagnosed asthma was assessed in a community-based sample of 4550 adolescents in South Western Sydney, Australia. The results of this survey found an asthma prevalence among 11-15-year-olds of 17.5%, being consistent with previous studies. Tobacco use and alcohol consumption were higher among asthmatic compared with nonasthmatic adolescents. Asthmatics reported feeling lonely more often, having a number of negative social perceptions and feelings, and having more frequent psychosomatic symptoms. The findings of the study suggest that adolescents with asthma represent an important vulnerable group of school children. Asthma education may need a greater life-style change focus, besides asthma self-management training.

Errores innatos del metabolismo valoración del alto riesgo / Inborn errors of metabolism

Los errores innatos del metabolismo son un grupo de enfermedades que se presenta con una frecuencia de 1 en 600 recién nacidos vivos, en las cuales existe una alteración de la función de una proteína. No se conoce la incidencia ni presentación de estos desórdenes en Colombia, pero en algunos centros especializados se está trabajando en su diagnóstico. En este trabajo, se recoge y analiza la información obtenida del estudio de 350 casos remitidos al Centro de Investigaciones en Bioquímica de la Universidad de los Andes, observando que aun en Colombia no existe una adecuada difusión de conocimientos en esta área, ya que la remisión de los pacientes es generalmente inadecuada. El análisis mostró que la frecuencia de su presentación va decreciendo a medida que aumenta la edad, que dentro de los motivos de remisión mas comunes se encuentran las convulsiones, las alteraciones del tono muscular y la regresión neurológica. Los diagnósticos con mayor número de casos fueron la fenilcetonuria y las mucopolisacaridosis aunque la mayoría aun se encuentran en estudio.

Utilisation rates of primary care services in an emergency department.

Rates of patients attending for primary care reasons at the emergency department of Campbelltown Hospital were estimated to identify trends in utilisation, reasons for attendance and social characteristics. The proportion of 'primary care' patients attending the emergency department is increasing. The reasons for the increase are not known and require further investigation.

Stabilization ponds in the tropics: promotion of the sanitary reuse of water.

This article reports the results of efforts by PAHO's Environmental Health Program to lay the groundwork for designing wastewater stabilization ponds suited to tropical areas. The resulting design concepts are flexible (permitting pond construction to be adapted to a broad range of terrains, community sizes, and working temperatures) and directed at meeting WHO standards established for the microbial quality of effluents used in agriculture and aquaculture. The WHO standards (1) call for treated wastewater being used in agriculture or aquaculture to contain less than 1,000 fecal coliforms per 100 ml. The plans outlined here, which are calculated to meet those standards, seek to minimize the pond area and volume needed by using two high-load primary anaerobic ponds discharging into an elongated secondary pond with a length-to-width ratio of at least 15:1. In rough terrain the elongated pond can be allowed to meander, following the land's natural contours. However, where the terrain is level it is recommended that a system of partitions be used to maintain the 15:1 ratio for operating purposes while changing the actual ratio of the secondary pond's outer dimensions to something like 5:3. Basic equations presented in the text will be helpful in estimating the pond sizes needed to cope with different climatic conditions, community sizes, per capita rates of wastewater generation, and per capita biochemical oxygen demands. While these equations should prove of great assistance during initial planning and development of preliminary criteria, nothing in this article supplants the topographic and geotechnologic studies that will be needed in order to clearly determine what is feasible in any given case.

Asthma prevalence and management in Australian adolescents: results from three community surveys.

Three population surveys of asthma, conducted as part of a community-based asthma education program in southwestern Sydney, Australia, illustrate the relationship between health behaviors and asthma morbidity. The first survey was carried out in five secondary schools (n = 2514, 52% participation rate); the second survey, in eight schools (n = 4550, 82% participation rate); and, the third survey was conducted among patients who attended 38 general practices in the region (n = 633 adolescents, 72% participation rate). The prevalence of diagnosed asthma in Australian adolescents across all three studies was 16.5% (95% CI, 15.7%-17.3%). Asthma prevalence declined in males, but increased in females from ages 12-15 years. It was noted that smoking prevalence was similar in asthmatic adolescents, compared with nonasthmatics, and that the adoption of smoking occurred at similar ages. Further, behavioral self-management of asthma was infrequent in this group, with low levels of preventive practice and preventive medication use. We present a conceptual model of the barriers to optimal asthma management among asthmatic adolescents. The results of these surveys have led to community-wide efforts to improve asthma management and decrease smoking prevalence among these adolescents.

Sampling bias in asthma surveys of patients attending general practitioners in south-western Sydney.

Results from asthma surveys in patients attending general practitioners were compared with data from population-based samples. The prevalence of asthma symptoms and optimal asthma management were more common in the GP attenders. Attention should be paid to potential sources of sampling bias in chronic disease prevalence research in primary care settings.