Dietary patterns across the life course, mammographic density and implications for breast cancer : results from a British prospective cohort

Background : Previous epidemiological studies have investigated the relationship between individual nutrients such as vitamin D and vitamin B12 and mammographic density, a strong marker of breast cancer risk [1], with varied results. There has been limited research on overall dietary patterns and most studies have focused on adult dietary patterns [2]. We examine prospective data to determine whether dietary patterns from childhood to adult life affect mammographic density.

Methods : The Medical Research Council National Survey of Health and Development is a national representative sample of 2,815 men and 2,547 women followed since their birth in March 1946 [3]. A wealth of medical and social data has been collected in over 25 follow-ups by home visits, medical examinations and postal questionnaires. Dietary intakes at age 4 years were determined by 24-hour recalls and in adulthood (ages 36, 43 years) by 5-day food records. Copies of the mammograms (two views for each breast) taken when the women were closest to age 50 years were obtained from the relevant NHS centres. A total of 1,319 women were followed up since birth in 1946 for whom a mammogram at age 50 years was retrieved, and the percentage mammographic density was measured using the computer-assisted threshold method for all 1,161 women. Breast cancer incidence for the whole cohort is being ascertained through the National Health Service Central Register.

Statistical analysis : Reduced rank regression analysis, a relatively new approach to dietary pattern analysis, is being used to identify dietary patterns associated with mammographic density [4]. This approach identifies patterns in food intake that are predictive of an intermediate outcome of the disease process, such as mammographic density, and subsequently examines the relationship between the identified dietary patterns and breast cancer risk.

Results : Preliminary analyses so far suggest that variations in dietary patterns in adulthood might explain more than 10% of the variation in percentage mammographic density at age 50 years (age 36 years: 13%; age 43 years: 14%), with variations in patterns in childhood explaining slightly less. Further work is being carried out on the characteristics of these dietary patterns and their effects on percentage mammographic density and its two components (that is, absolute areas of dense and nondense tissues) and on breast cancer risk, after adjusting for socioeconomic status, anthropometric variables and reproductive factors.

Conclusion : The present study will provide for the first time information on the relationship between dietary patterns across the life course and mammographic density, and will help to clarify the pathways through which diet may affect breast cancer risk.

Ghosts in the machine : student participation and grade attainment in a web-assisted social work course

For many social work educators, the debate about whether social work education should be delivered using online technology has, as a result of institutional imperatives, moved on to how best this can be done. In this article, the process of designing and delivering part of a social work course using asynchronous online discussion is described and reflected upon. Student participation in the online environment is also compared with final course grades and the findings discussed in relation to existing literature. Recommendations for the future delivery of social work courses using online technology emerging from this discussion are offered.

Case study of electronic networking in an initial teacher education course

Electronic networking ('computer-mediated communication1), considered to be ‘unique domain for educational activity’ (Harasim, 1989:50) and ‘new educational paradigm’ (Mason & Kaye, 1989:23), has been widely used and researched in K-12 schooling, place-based undergraduate subjects and distance education courses. However, only a limited number of reports of usage with experienced teachers (professional development), beginning teachers (induction support) and trainee teachers (initial training) have been published. Hence, little is known about the ways in which this new medium might contribute to the acquisition and maintenance of professional knowledge in the field of teacher education. The purpose of this study was to document an application of electronic networking in an initial 'school-based1 teacher education course. Three factors which were considered to be important in the adoption of electronic networking were specifically addressed: (a) the potential of the medium to attract and maintain a representative and comprehensive audience', (b) the willingness of participants to use the medium for the notation of ideas about teaching; and, (c) the extent to which reflection on practice was evident in network messages. This study also identified and investigated other effects which emerged as participants attempted to negotiate personal relationships with new technology. A case study was selected to investigate audience, notation, reflection, and other effects, in a particular application. Data were collected using participant observation, software-generated statistics, printed documentation, university records, questionnaires, interviews and content analysis of messages. These data were used to describe and analyse network participation by trainee teachers, classroom teachers and university staff. The data revealed that an audience did exist on the electronic network but that this was not comprehensive. Teachers had difficulty accessing the network because of other school commitments, access to equipment and personal competence with microcomputers. These difficulties indicated that developing and maintaining the teacher audience may be a major problem with electronic networking in initial teacher education. This case study revealed that deeply held concerns about notation of ideas by trainee teachers and classroom teachers can be powerful reasons for limited network participation. For trainee teachers, recording ideas publicly presented special difficulties associated with written communication. They were concerned about writing for an audience; about what to write about and how to write it. The loss of visual and verbal cues which form part of face-to-face communication was also a problem leading to concerns about how messages would be received by others. However, the overwhelming concern of almost all trainee teachers about presenting their own ideas was Tear of criticism' from peers (in particular), and other participants on the network. Trainee teachers expressed concerns about the 'dangers' of putting their thoughts in writing, the scrutiny their messages might have received from others, and the public 'criticism' about what they wrote which might have appeared on the network. Knowing that messages were stored on the network, and could be retrieved at some later date, heightened anxiety about the vulnerability of written communication; what was written on one occasion may have to be defended at some later date when the views expressed initially were no longer held. Classroom teachers were also unsure about recording their own ideas in an electronic form. Like trainee teachers, they were concerned about the scrutiny their contributions might receive from other users, and the lack of visual and verbal cues which they had learnt to use in face-to-face communication. Notating ideas in text-based messages which were archived (by the software), and retrievable by others later, was also daunting to many teachers. Another major 'danger' for teachers was the possible repercussions of 'public comment' about curriculum policy and initiatives which they thought might get them into 'trouble' with their employer. Since very few messages were contributed to conferences, there was little evidence of reflection in network communication. In the main, the network was not used to share information and ideas about curriculum and teaching. Public examples of collaboration between participants were not evident, and the 'special knowledge' held by members in each distinct group of users was not elaborated and discussed. Messages were not used to request information or clarification about issues, to outline the processes by which decisions about teaching were reached, or to synthesis ideas from different sources. The potential of the medium to operationalise reflective practice was not realised. Among the effects observed, the use of an anonymous account to access the network, and the impact this had on participation (in one conference) was considered to be a particularly significant finding. While the opportunity to systematically investigate the effects of anonymity on network participation and message contributions was not realised (by the author) while the research was in progress, the effects observed and discussed are considered to be important and worthy of further investigation. In this case study, the anonymous account helped trainee teachers mask concerns about personal writing skills and fear of criticism from others, indicating that anonymity may alter communication patterns, particularly in the early stages of network use. Given the data collected in this case study, and the interpretations placed on it by the author, a pessimistic assessment of the place of electronic networking in initial teacher education courses was presented. For this situation to change - that is, for electronic discussions to become more fully integrated into course activities - four issues which need to be addressed were identified and discussed. These included clarification of the role of collaboration amongst participants in initial teacher education, the ways in which collaboration can be facilitated using electronic networking, the problems of notation - such as the difficulty of expressing ideas about teaching in written form, and the concerns about permanently archived messages - for teachers and trainee teachers, and the lack of skills which many trainee teachers bring to electronic discussions. In the context of initial teacher education, it was suggested that these four aspects require clarification and development before the potential advantages of electronic networking can be realised. Some specific suggestions about how these issues might be resolved were presented.

Effectiveness of a community-based osteoporosis education and self-management course : a wait list controlled trial

Summary : Osteoporosis is an increasing burden on individuals and health resources. The Osteoporosis Prevention and Self-Management Course (OPSMC) was designed to assist individuals to prevent and manage osteoporosis; however, it had not been evaluated in an Australian setting. This randomised controlled trial showed that the course increased osteoporosis knowledge.
Introduction and hypothesis : Osteoporosis is a major and growing public health concern. An OPSMC was designed to provide individuals with information and skills to prevent or manage osteoporosis, but its effectiveness has not previously been evaluated. This study aimed to determine whether OPSMC attendance improved osteoporosis knowledge, self-efficacy, self-management skills or behaviour.
Materials and methods : Using a wait list randomised controlled trial design, 198 people (92% female) recruited from the community and aged over 40 (mean age = 63) were randomised into control (n = 95) and intervention (n = 103) groups. The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators. The primary outcome were osteoporosis knowledge, health-directed behaviour, self-monitoring and insight and self-efficacy.
Results : The groups were comparable at baseline. At 6-week follow-up, the intervention group showed a significant increase in osteoporosis knowledge compared with the control group; mean change 3.5 (p < 0.001) on a measure of 0–20. The intervention group also demonstrated a larger increase in health-directed behaviour, mean change 0.16 (p < 0.05), on a measure of 0–6.
Conclusion : The results indicate that the OPSMC is an effective intervention for improving understanding of osteoporosis and some aspects of behaviour in the short term.

Making a difference with a discrete course on accounting ethics

Calls for the expansion of ethics education in the business and accounting curricula have resulted in a variety of interventions including additional material on ethical cases, the code of conduct, and the development of new courses devoted to ethical development [Lampe, J.: 1996]. The issue of whether ethics should be taught has been addressed by many authors [see for example: Hanson, K. O.: 1987; Huss, H. F. and D. M. Patterson: 1993; Jones, T. M.: 1988–1989; Kerr, D. S. and L. M. Smith: 1995; Loeb, S. E.: 1988; McDonald, G. M. and G. D. Donleavy: 1995]. The question addressed in this paper is not whether ethics should be taught but whether accounting students can reason more ethically after an intervention based on a discrete and dedicated course on accounting ethics. The findings in this paper indicate that a discrete intervention emphasising dilemma discussion has a positive and significant effect on students’ moral reasoning and development. The data collected from interviews suggest that the salient influences on moral judgement development include: learning theories of ethics particularly Kohlberg’s theory of cognitive moral reasoning and development; peer learning; and moral discourse. The implications from the findings in this study suggest that moral reasoning is responsive to particular types of ethics intervention and educators should carefully plan their attempts to foster moral judgement development.

Course websites, computer proficiency and need for achievement : implications for MBA student performance

Course websites have become a basic requirement for course promotion and delivery in many universities. This study explores the relationship between perceived usefulness of course websites and student performance in an accounting course within a Masters of Business Administration (MBA) programme. Data from 48 students were found to support several hypotheses. Specifically, the findings of the study indicate that there is a significant correlation between the perceived usefulness of course website features such as lecture notes, tutorial questions and solutions and the frequency of use or access by students of such course website features. Further, we found that the perceived usefulness of course websites was positively related to students’ computer proficiency, but not with the frequency with which students missed classes. The findings also indicate that students with high need for achievement achieved better performance scores, but there was no significant relationship between perceived usefulness of course website and performance. These findings have several implications for the design and development of course websites at post-graduate level, and for future research examining the link between information technology and accounting education.

Prevention of a chronic progressive form of experimental autoimmune encephalomyelitis by an antibody against mucosal addressin cell adhesion molecule-1, given early in the course of disease progression.

A role for α4 and β7 integrins in mediating leucocyte entry into the central nervous system in the multiple sclerosis (MS)-like disease experimental autoimmune encephalomyelitis (EAE) has been demonstrated. However, the individual contributions of their respective ligands mucosal addressin cell adhesion molecule-1 (MAdCAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-cadherin expressed on the blood-brain barrier has not been determined. In the present paper, it is shown that an antibody directed against MAdCAM-1, the preferential ligand for α4β7, effectively prevented the development of a progressive, non-remitting, form of EAE, actively induced by injection of myelin oligodendrocyte glycoprotein peptide (MOG(_35-55)) autoantigen. Combinational treatment with both anti-MAdCAM-1, VCAM-1, and intercellular adhesion molecule-1 (ICAM-1) (ligand for integrin lymphocyte function-associated antigen (LFA)-1) mAbs led to more rapid remission than that obtained with anti-MAdCAM-1 antibody alone. However, neither MAdCAM-1 monotherapy, nor combinational antibody blockade was preventative when administered late in the course of disease progression. In conclusion, MAdCAM-1 plays a major contributory role in the progression of chronic EAE and is a potential therapeutic target for the treatment of MS. Critically, antivascular addressin therapy must be given eaA role for alpha4 and beta7 integrins in mediating leucocyte entry into the central nervous system in the multiple sclerosis (MS)-like disease experimental autoimmune encephalomyelitis (EAE) has been demonstrated. However, the individual contributions of their respective ligands mucosal addressin cell adhesion molecule-1 (MAdCAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-cadherin expressed on the blood-brain barrier has not been determined. In the present paper, it is shown that an antibody directed against MAdCAM-1, the preferential ligand for alpha4beta7, effectively prevented the development of a progressive, non-remitting, form of EAE, actively induced by injection of myelin oligodendrocyte glycoprotein peptide (MOG(35-55)) autoantigen. Combinational treatment with both anti-MAdCAM-1, VCAM-1, and intercellular adhesion molecule-1 (ICAM-1) (ligand for integrin lymphocyte function-associated antigen (LFA)-1) mAbs led to more rapid remission than that obtained with anti-MAdCAM-1 antibody alone. However, neither MAdCAM-1 monotherapy, nor combinational antibody blockade was preventative when administered late in the course of disease progression. In conclusion, MAdCAM-1 plays a major contributory role in the progression of chronic EAE and is a potential therapeutic target for the treatment of MS. Critically, antivascular addressin therapy must be given early in the course of disease prior to the establishment of irreversible damage if it is to be effective, as a single treatment modality.