Recruitment methods for community-based screening for diabetic retinopathy

Regular screening of all people with diabetes is the most efficient and cost-effective way to detect early stages of diabetic retinopathy so that laser treatment can be performed at the optimal time. A major aim of the Program for the Early Detection of Diabetic Retinopathy was to increase compliance with guidelines for screening for diabetic retinopathy. This community-based screening program used non-mydriatic retinal photography and was initiated in four areas of Victoria, Australia from 1996-1998. Recruitment strategies included targeted mail-outs, provision of the program brochure in English and the main languages spoken in the areas and media promotion in ethnic newspapers and on ethnic radio stations. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. This program was able to increase compliance with guidelines to 70% among people with diabetes that had not had a recent eye examination. A total of 1,197 people with diabetes were screened for diabetic retinopathy. Of the 1,197 people who were screened, 620 (15% of the estimated number of people with diabetes) had not had their eyes examined in the past two years. This pilot study identified strategies to encourage people with diabetes to have their eyes examined at the recommended intervals.

Higher adherence to the Australian dietary guidelines is associated with better mental health status among Australian adult first-time mothers

Background: Mental health disorders are a leading cause of disability worldwide, including in first-time mothers. Understanding the associations between diet and depressive symptoms could assist in improving mental health status in this group. Objective: Our aim was to determine the association between diet quality, fruit, vegetable, and fish consumption and depressive symptoms in first-time mothers aged 19 to 45 years.

Design: We analyzed cross-sectional, baseline data (3 months postpartum) from the Melbourne InFANT (Infant Feeding, Activity, and Nutrition Trial) Extend Program.

Participants/setting: Participants were first-time Australian mothers aged 19 to 45 years from the Geelong and Melbourne regions of Victoria, Australia (n=457).

Main outcome measures: A self-administered, 137-item food frequency questionnaire assessed dietary intake over the past year. Adherence to the 2013 Australian Dietary Guidelines was assessed using the Dietary Guideline Index as a measure of diet quality. Depressive symptoms were determined using the Center for Epidemiologic Studies Depression Scale.

Statistical analysis performed: Relationships between diet quality, fruit, vegetable, and fish intake and depressive symptoms were investigated using linear regression adjusted for relevant covariates (age, smoking status, sleep quality, education, physical activity status, and body mass index).

Results: Better diet quality, as indicated by a higher score on the Dietary Guideline Index, was associated with lower depressive symptoms after adjusting for relevant covariates (β=-.034; 95% CI -.056 to -0.012). There were no other associations between dietary intake and depressive symptoms.

Conclusions: Adherence to the Australian Dietary Guidelines was associated with better mental health status among first-time mothers. Further research, including longitudinal and intervention studies, are required to determine causality between dietary intake and depressive symptoms, which might help inform future public health nutrition programs for this target group.

Implementing guidelines to routinely prevent chronic vascular disease in primary care: the preventive evidence into practice cluster randomised controlled trial

Objective: To evaluate an intervention to improve implementation of guidelines for the prevention of chronic vascular disease. Setting: 32 urban general practices in 4 Australian states. Randomisation: Stratified randomisation of practices. Participants: 122 general practitioners (GPS) and practice nurses (PNs) were recruited at baseline and 97 continued to 12 months. 21 848 patient records were audited for those aged 40-69 years who attended the practice in the previous 12 months without heart disease, stroke, diabetes, chronic renal disease, cognitive impairment or severe mental illness. Intervention: The practice level intervention over 6 months included small group training of practice staff, feedback on audited performance, practice facilitation visits and provision of patient education and referral information. Outcome measures: Primary: 1. Change in proportion of patients aged 40-69 years with smoking status, alcohol intake, body mass index (BMI), waist circumference (WC), blood pressure (BP) recorded and for those aged 45-69 years with lipids, fasting blood glucose and cardiovascular risk in the medical record. 2. Change in the level of risk for each factor. Secondary: change in self-reported frequency and confidence of GPS and PNs in assessment. Results: Risk recording improved in the intervention but not the control group for WC (OR 2.52 (95% CI 1.30 to 4.91)), alcohol consumption (OR 2.19 (CI 1.04 to 4.64)), smoking status (OR 2.24 (1.17 to 4.29)) and cardiovascular risk (OR 1.50 (1.04 to 2.18)). There was no change in recording of BP, lipids, glucose or BMI and no significant change in the level of risk factors based on audit data. The confidence but not reported practices of GPS and PNs in the intervention group improved in the assessment of some risk factors. Conclusions: This intervention was associated with improved recording of some risk factors but no change in the level of risk at the follow-up audit. Trial registration number: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12612000578808, results.