Prospective memory rehabilitation for adults with traumatic brain injury: A compensatory training programme

Primary objective: To describe a prospective memory rehabilitation programme based on a compensatory training approach and report the results of three case studies. Research design: Programme evaluation using pre-and post-intervention assessments and telephone follow-up. Methods and procedures: Three participants with traumatic brain injury completed 8 weeks of training with 1 - 2 hour individual sessions. Assessments were formal prospective memory assessment, self-report and measures of diary use. Experimental interventions: Intervention aimed to identify potential barriers, establish self-awareness of memory deficits, introduce a customized compensatory tool, a cueing system and organizational strategies. A significant other was involved in training to assist generalization. Main outcomes and results: All three participants improved on formal prospective memory assessment and demonstrated successful diary use after the programme. Self-report of prospective memory failure fluctuated and may reflect increased self-awareness. Conclusion: A compensatory approach may be useful in improving prospective memory performance following TBI.

Assessing the effectiveness of a mammography screening service

Background: Trials have shown that mammography screening reduces mortality and probably decreases morbidity related to breast cancer. Methods: We assessed whether the major mammography service in Western Australia (BreastScreen WA) is likely to reduce mortality by comparing prognostic variables between screen-detected and other cases of breast cancer diagnosed in 1999. We assessed likely reductions in morbidity by comparing treatments received by these two groups. To confirm mortality and morbidity reduction, we also compared prognostic variables and treatments with targets. Information on demographic variables, tumour characteristics at presentation and treatments were collected from medical records for all incident cases of breast cancer in Western Australia in 1999. We matched cases with the Western Australian Cancer Registry records to determine which cases had been detected by BreastScreen WA. Results: BreastScreen WA achieved the targets for mortality reduction. Tumours detected by BreastScreen WA were smaller in size, less likely to have vascular invasion, of lower histological grade and were more likely to be ductal carcinoma in situ alone without invasive carcinoma. Oestrogen receptor status was more likely to be positive, the difference in progesterone status was not significant, and lymph node involvement tended to be lower. BreastScreen WA patients were treated more often with local therapy and less often with systemic therapy, and the proportion of patients treated with breast-conserving surgery was close to the target for minimizing morbidity in breast cancer. Conclusion: Mammographic detection of breast cancer by BreastScreen WA is associated with reduced breast cancer morbidity and a more favourable prognosis.

Community-based programmes to prevent falls in children: A systematic review

Objective: We systematically reviewed the literature to examine the evidence for the effectiveness of community-based interventions to reduce fall-related injury in children aged 0-16 years. Methods: We performed a comprehensive search of the literature using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years; outcome measure was fall-related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Results: Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre- and post-intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult. Conclusion: There is a paucity of research studies from which evidence regarding the effectiveness of community-based intervention programmes for the prevention of fall-related injury in children could be based.

Physical activity measurement - a primer of health promotion

As the importance of physical activity is recognised in health promotion, the task of measuring it becomes a central research and practice challenge. Measurement of physical activity is important to policy makers interested in population surveillance, as well as to practitioners interested in programme evaluation and research. This review outlines 'best practice' in physical activity measurement, and provides an inventory of established physical activity and related measures for use in health promotion programme evaluation, research and surveillance at the national and local level. [PUBLICATION ABSTRACT]

Kick'n'on: The design and evaluation of a group programme for young males with psychotic disorders

Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

Acceptability and feasibility of a community-based screening programme for melanoma in Australia

The evaluation of a community-based screening programme for melanoma (SkinWatch) in 18 regional communities (total adult population >30 years 63 035) in Queensland, Australia is described. The aim of the SkinWatch programme was to promote whole-body skin screening for melanoma by primary care physicians. The programme included community education, education and support for local medical practitioners and open-access skin screening clinics. Programme delivery was achieved through assistance of local volunteers. All programme activities and resources were recorded for process evaluation. A baseline telephone survey (n = 3110) and a telephone survey four months after programme launch (n = 680) assessed community awareness of the SkinWatch programme and, 37 face-to-face interviews with community members, doctors and community leaders were conducted to assess satisfaction with the programme. A sample of 1043 of 16 383 residents who attended the skin screening clinics provided as part of the programme were interviewed to assess reasons for attending, and positive and negative aspects of SkinWatch programme. Community awareness of the SkinWatch programme increased by over 30% (p < 0.001) within four months of the start of the programme. Interview participants described the SkinWatch programme as a useful service for the communities and 90% stated they would revisit the clinics. A total of 43% of all attendees were over 50 years old, and nearly 50% were men. These findings demonstrate the acceptability and feasibility of a community-based screening programme for melanoma in rural areas. Volunteers were instrumental in increasing community ownership of and involvement in the SkinWatch programme.

Use of the Vector (TM) scaling unit in supportive periodontal therapy: a subjective patient evaluation

Background: Patient discomfort is one reason for poor compliance with supportive periodontal therapy (SPT). The aim of this study was to compare the levels of discomfort during SPT, using the Vector (TM) system and treatment with a conventional ultrasonic scaler. Methods: Forty-six patients with an SPT programme were debrided using both the Vector (TM) system and a conventional piezo-electric scaler (Sirona (TM)) in a split mouth design. A visual analogue scale was used to evaluate of pain scores upon completion of treatment. A verbal response scale(VRS) was used to assess discomfort, vibration and noise associated with the scaling system, as well as the volume and taste of the coolant used by these systems. Results: Patients instrumented with the Vector (TM) system experienced approximately half the amount of pain compared with the conventional ultrasonic scaling system. The VRS showed that the Vector (TM) system caused less discomfort than the conventional ultrasonic scaling system when assessed for pain, vibration, noise and volume of coolant. These findings were all statistically significant. There was, however, no statistically significant difference between the two systems when assessed for taste. Conclusion: During SPT the Vector (TM) system caused reduced discomforting sensations compared with conventional methods and may be useful in improving compliance with SPT programmes.

Evaluation of the healthy village program in Kapit district, Sarawak, Malaysia

Sarawak, Malaysia has a large population of ethnic minorities who live in longhouses in remote rural areas where poverty, non-communicable diseases, accidents and injuries, environmental hazards and communicable diseases all contribute to a lower quality of life than is possible to achieve in these regions. To address these issues and improve the quality of life for longhouse people, the Kapit Divisional Health Office implemented the World Health Organization's Healthy Village programme in 2000. An evaluation was undertaken in 2003 to determine physical and behavioural changes resulting from the programme. The main changes evaluated were those involving smoking habits, exercise habits, health screening, fire safety, environmental improvements and food preparation and hygiene. A qualitative evaluation was conducted using participant observation and key-informant interviews, focus groups and observation. Results indicate that the programme is inspiring changes in various behavioural and physical characteristics of the study population. It is clear that the Healthy Village programme is a widely accepted way of improving health outcomes in longhouses, and that it is succeeding in making beneficial health changes.

Evaluation of the indirect measures of rock brittleness and fracture toughness in rock cutting

Performance prediction models for partial face mechanical excavators, when developed in laboratory conditions, depend on relating the results of a set of rock property tests and indices to specific cutting energy (SE) for various rock types. There exist some studies in the literature aiming to correlate the geotechnical properties of intact rocks with the SE, especially for massive and widely jointed rock environments. However, those including direct and/or indirect measures of rock fracture parameters such as rock brittleness and fracture toughness, along with the other rock parameters expressing different aspects of rock behavior under drag tools (picks), are rather limited. With this study, it was aimed to investigate the relationships between the indirect measures of rock brittleness and fracture toughness and the SE depending on the results of a new and two previous linear rock cutting programmes. Relationships between the SE, rock strength parameters, and the rock index tests have also been investigated in this study. Sandstone samples taken from the different fields around Ankara, Turkey were used in the new testing programme. Detailed mineralogical analyses, petrographic studies, and rock mechanics and rock cutting tests were performed on these selected sandstone specimens. The assessment of rock cuttability was based on the SE. Three different brittleness indices (B1, B2, and B4) were calculated for sandstones samples, whereas a toughness index (T-i), being developed by Atkinson et al.(1), was employed to represent the indirect rock fracture toughness. The relationships between the SE and the large amounts of new data obtained from the mineralogical analyses, petrographic studies, rock mechanics, and linear rock cutting tests were evaluated by using bivariate correlation and curve fitting techniques, variance analysis, and Student's t-test. Rock cutting and rock property testing data that came from well-known studies of McFeat-Smith and Fowell(2) and Roxborough and Philips(3) have also been employed in statistical analyses together with the new data. Laboratory tests and subsequent analyses revealed that there were close correlations between the SE and B4 whereas no statistically significant correlation has been found between the SE and T-i. Uniaxial compressive and Brazilian tensile strengths and Shore scleroscope hardness of sandstones also exhibited strong relationships with the SE. NCB cone indenter test had the greatest influence on the SE among the other engineering properties of rocks, confirming the previous studies in rock cutting and mechanical excavation. Therefore, it was recommended to employ easy-to-use index tests of NCB cone indenter and Shore scleroscope in the estimation of laboratory SE of sandstones ranging from very low to high strengths in the absence of a rock cutting rig to measure it until the easy-to-use universal measures of the rock brittleness and especially the rock fracture toughness, being an intrinsic rock property, are developed.