Promoting better use of the PSA test in general practice: Randomized controlled trial of educational strategies based on outreach visits and mailout

Background. Prostate-specific antigen (PSA) testing for prostate cancer is controversial. Demand for PSA testing is likely to rise in the UK, Australia and other western countries. Primary care needs to develop appropriate strategies to respond to this demand. Objectives. Our aim was to compare the effectiveness of educational outreach visits (EOVs) and mailout strategies targeting PSA testing in Australian primary care. Methods. A randomized controlled trial was conducted in general practices in southern Adelaide. The main outcome measures at baseline, 6 months and 12 months post-intervention were PSA testing rates and GP knowledge in key areas relating to prostate cancer and PSA testing. Results. The interventions were able to demonstrate a change in clinical practice. In the 6 months post-intervention, median PSA testing rate in the EOV group was significantly lower than in the postal group, which in turn was significantly lower than the control group (P < 0.001). Statistically significant differences were not, however, maintained in the 6-12 month post-intervention period. The EOV group, at 6 months follow-up, had a significantly greater proportion of 'correct' responses than the control group to questions about prostate cancer treatment effectiveness (P = 0.004) and endorsement of PSA screening by professional bodies (P = 0.041). Conclusions. Primary care has a central role in PSA testing for prostate cancer. Clinical practice in this area is receptive to evidence-based interventions.

Scaffolding and bilingual shared reading experiences: Promoting primary school students' learning and development

This paper explores the connections between scaffolding, second language learning and bilingual shared reading experiences. A socio- cultural theory of cognition underpins the investigation, which involved implementing a language and culture awareness program (LCAP) in a year 4 classroom and in the school community. Selected passages from observations are used to analyse the learning of three students, particularly in relation to languages other than English (LOTE). As these three case study students interacted in the classroom, at home and in the community, they co-constructed, appropriated and applied knowledge form one language to another. Through scaffolding, social spaces were constructed, where students learning and development were extended through a variety of activities that involved active participation, such as experimenting with language, asking questions and making suggestions. Extending these opportunities for student learning and development is considered in relation to creating teaching and learning environments that celebrate socio-cultural and linguistic diversity.

Adolescents' willingness to seek psychological help: Promoting and preventing factors

Although a relatively high percentage of Australian adolescents experience mental health problems, many disturbed adolescents do not receive the help they require, and only a small proportion of adolescents seek professional psychological help. The present study examined adolescents' willingness to seek help and investigated factors that promote and prevent adolescents from seeking help for a mental illness from both formal and informal sources. Secondary school students (254 in number) from schools in Brisbane, Australia completed a questionnaire that examined the relationship between demographic and psychological variables, attitudes toward mental illness, and willingness to seek help for a mental illness. Results suggest that adolescents with greater adaptive functioning, fewer perceived barriers to help seeking, and higher psychological distress were more willing to seek help from formal and informal sources for a mental illness. Greater social support also predicted willingness to seek help from informal sources. Although attitudes toward mental illness did not influence willingness to seek help, less stigmatising attitudes were related to higher knowledge of mental illness, being female, and higher levels of social support. Implications for the present study focus on enhancing the ability of mental health interventions to increase adolescents' willingness to seek psychological help.

Promoting physical activity in Australian general practices: a randomised trial of health promotion advice versus hypertension management

A randomised controlled trial was conducted to determine if physicians' advice to promote physical activity to patients was more effective if the advice was tailored to the management of hypertension, compared with more general health promotion advice. Participants included inactive 40- to 70-year-old patients visiting the physicians' during study recruitment period. Physicians provided verbal physical activity advice and written materials, both tailored to either general health promotion messages or specifically as a means for treating or managing hypertension. Seventy-five physicians and 98% (767/780) of screened eligible patients participated in the study. Differences between intervention and control groups self-reported physical activity were assessed over 6 months. Follow-up response rates were 92 and 84% at the 2- and 6-month assessments. There were no consistent, significant differences between groups at the 2- or 6-month assessments. Thus, neither intervention strategy resulted in significant changes in patients self-reported physical activity, regardless of the whether the advice was tailored to hypertension management or general health promotion advice. (c) 2004 Elsevier Ireland Ltd. All rights reserved.

Piloting the feasibility and effectiveness of print- and telephone-mediated interventions for promoting the adoption of physical activity in Australian adults

This study examined the feasibility and effectiveness for increasing physical activity of a print-based intervention, and a print- plus telephone-mediated intervention among mid-life and older Australian adults. A randomised controlled trial study design was used. In mid-2002, 66 adults (18 men, 48 women) aged 45-78 years, who identified themselves as under-active, were recruited through advertisements and word-of-mouth at two sites (Melbourne and Brisbane), and randomised to either the print or print-plus-telephone mediated intervention group. Participants in both groups attended an initial briefing session, and over the 12-week intervention period received an instructional newsletter and use of a pedometer (both groups), and individualised telephone calls (print- plus-telephone group only). Self-reported physical activity data were collected at baseline, 12 and 16 weeks. Measures of self-reported global physical activity, moderate-vigorous intensity activity and walking all showed increases between baseline and 12 weeks for both intervention groups. These increases were generally maintained by 16 weeks, although participants in the print-plus-telephone group maintained slightly higher levels of global reported activity and walking (by approximately 30 mins/wk) than those in the print group. These interventions show potential for promoting initial increases in physical activity among mid-life and older Australian adults, and should be evaluated across more extended time periods.

A review of the potential role of tumour-promoting compounds produced by Lyngbya majuscula in marine turtle fibropapillomatosis

Harmful algal blooms (HABs) have increased in abundance and severity in recent decades. Whereas the implications for human impacts and intoxication resulting from blooms have been extensively studied, the ecological implications of these microalgae are less well understood. Many HAB species produce biologically active, secondary metabolites and the fate of these toxins through the foodweb is generally not well understood unless it culminates in extensive fish mortalities or human poisonings. This review focusses on one HAB species, the cyanobacterium Lyngbya majuscula, and presents a hypothetical role for its involvement in fibro-papillornatosis (FP), a neoplastic disease of marine turtles. FP is expressed as benign tumours that grow both internally and externally on marine turtles, preventing vision, movement and organ function. The aetiology of FP is currently not conclusively understood, but virus material has been associated with tumours and previous studies have suggested a role for naturally produced tumour promoters. In this review, we present a hypothesis regarding the involvement of L. majuscula in FP, either through direct intoxication and action of tumour-promoting compounds or indirectly by causing seagrass loss and compromised immune function, thus leaving the turtles more susceptible to disease.

Patched1 functions as a gatekeeper by promoting cell cycle progression

Mutations in the Hedgehog receptor, Patched 1 (Ptch1), have been linked to both familial and sporadic forms of basal cell carcinoma (BCC), leading to the hypothesis that loss of Ptch1 function is sufficient for tumor progression. By combining conditional knockout technology with the inducible activity of the Keratin6 promoter, we provide in vivo evidence that loss of Ptch1 function from the basal cell population of mouse skin is sufficient to induce rapid skin tumor formation, reminiscent of human BCC. Elimination of Ptch1 does not promote the nuclear translocation of beta-catenin and does not induce ectopic activation or expression of Notch pathway constituents. In the absence of Ptch1, however, a large proportion of basal cells exhibit nuclear accumulation of the cell cycle regulators cyclin D1 and B1. Collectively, our data suggest that Ptch1 likely functions as a tumor suppressor by inhibiting G(1)-S phase and G(2)-M phase cell cycle progression, and the rapid onset of tumor progression clearly indicates Ptch1 functions as a gatekeeper. In addition, we note the high frequency and rapid onset of tumors in this mouse model makes it an ideal system for testing therapeutic strategies, such as Patched pathway inhibitors.

Promoting Learning for Sustainability: Principals' Perceptions of the Role of Outdoor and Environmental Education Centres

Outdoor and Environmental Education Centres provide programs that are designed to address a range of environmental education aims, and contribute broadly to student learning for sustainability. This paper examines the roles such Centres can play, and how they might contribute to the Australian Government’s initiative in relation to sustainable schools. Interviews with the principals of 23 such Centres in Queensland revealed three roles or models under which they operate: the destination model; the expert/advisor model; and the partnership model. Principals’ understandings of these roles are discussed and the factors that support or hinder their implementation are identified. It is concluded that while the provision of programs in the environment is still a vital role of outdoor and environmental education centres, these can also be seen as a point of entry to long-term partnerships with whole school communities.