Apixaban for the prevention of thromboembolism in adults after elective hip or knee replacement surgery, and in symptomatic venous thromboembolism

The anticoagulant effect of apixaban is due to direct inhibition of FXa in the coagulation cascade. The main advantages apixaban has over the current anti-coagulant drugs is that it is active after oral administration, and its coagulation effect does not require monitoring. Apixaban has been compared to enoxaparin in the prevention of venous thromboembolism associated with knee and hip replacement, where it is as efficacious as enoxaparin, but causes less bleeding. However, apixaban is not the only FXa inhibitor that could replace enoxaparin for this indication, as the FXa inhibitor rivaroxaban is as efficacious and safe as enoxaparin in preventing thromboembolism associated with these surgical procedures. Until the results of the AMPLIFY Phase III trial are known, it is too early to consider apixaban as an alternative to enoxaparin in symptomatic thromboembolism. Apixaban should not be used to prevent thromboembolism in medical immobilised subjects or acute coronary syndromes, as it causes excess bleeding in these conditions without benefit.

Transport injury risks in Queensland adolescents of Pacific Islander descent

Ethnicity is rarely considered in the development of injury prevention programs, despite its known impact on participation in risk behaviour. This study sought to understand engagement in transport related risk behaviours, patterns of injury and perceptions of risk among early adolescents who self-identify as being from a Pacific Islander background. In total 5 high schools throughout Queensland, Australia were recruited, of which 498 Year 9 students (13-14 years) completed questionnaires relating to their perceptions of risk and recent injury experience (specifically those transport behaviours that were medically treated and those that were not medically treated). The transport related risk behaviours captured in the survey were bicycle use, motorcycle use and passenger safety (riding with a drink driver and riding with a dangerous driver). The results are explored in terms of the prevalence of engagement in risky transport related behaviour among adolescents’ of Pacific Islander background compared to others of the same age. The results of this study provide an initial insight into the target participants’ perspective of risk in a road safety context as well as their experience of such behaviour and related injuries. This information may benefit future intervention programs specific to adolescents’ of Pacific Islander background.

Evaluation of screening tests for predicting older driver performance and safety assessed by an on-road test

A number of tests and test batteries are available for the prediction of older driver safety, but many of these have not been validated against standardized driving outcome measures. The aim of this study was to evaluate a series of previously described screening tests in terms of their ability to predict the potential for safe and unsafe driving. Participants included 79 community-dwelling older drivers (M=72.16 years, SD=5.46; range 65-88 years; 57 males and 22 females) who completed a previously validated multi-disciplinary driving assessment, a hazard perception test, a hazard change detection test and a battery of vision and cognitive tests. Participants also completed a standardized on-road driving assessment. The multi-disciplinary test battery had the highest predictive ability with a sensitivity of 80% and a specificity of 73%, followed by the hazard perception test which demonstrated a sensitivity of 75% and a specificity of 61%. These findings suggest that a relatively simple and practical battery of tests from a range of domains has the capacity to predict safe and unsafe driving in older adults.

Strategies for the prevention of cervical cancer by human papillomavirus vaccination

As cervical cancer is causally associated with 14 high-risk types of human papillomavirus (HPV), a successful HPV vaccine will have a major impact on this disease. Although some persistent HPV infections progress to cervical cancer, host immunity is generally able to clear most HPV infections. Both cell-mediated and antibody responses have been implicated in influencing the susceptibility, persistence or clearance of genital HPV infection. There have been two clinical trials that show that vaccines based on virus-like particles (VLPs) made from the major capsid protein, L1, are able to type specifically protect against cervical intra-epithelial neoplasia and infection. However, there is no evidence that even a mixed VLP vaccine will protect against types not included in the vaccine, and a major challenge that remains is how to engineer protection across a broader spectrum of viruses. Strategies for production of HPV vaccines using different vaccine vectors and different production systems are also reviewed. © 2005 Elsevier Ltd. All rights reserved.

Vaccination strategies for the prevention of cervical cancer

Infection with high-risk human papillomaviruses (HPVs) is an essential step in the multistep process leading to cervical cancer. There are approximately 120 different types of HPV identified: of these, 18 are high-risk types associated with cervical cancer, with HPV-16 being the dominant type in most parts of the world. The major capsid protein of papillomavirus, produced in a number of expression systems, self assembles to form virus-like particles. Virus-like particles are the basis of the first generation of HPV vaccines presently being tested in clinical trials. Virus-like particles are highly immunogenic and afford protection from infection both in animal models and in Phase IIb clinical trials. A number of Phase III trials are in progress to determine if the vaccine will protect against cervical disease and, in some cases, genital warts. However, it is predicted that these vaccines will be too expensive for the developing world, where they are desperately needed. Another problem is that they will be type specific. Novel approaches to the production of virus-like particles in plants, second-generation vaccine approaches including viral and bacterial vaccine vectors and DNA vaccines, as well as different routes of immunization, are also reviewed. © 2005 Future Drugs Ltd.

Reducing road related injuries for young adolescents : an investigation of truancy as a risk factor

Truancy is recognised as an indicator of engagement in high-risk behaviours for adolescents. Injuries from road related risk behaviours continue to be a leading cause of death and disability for early adolescents (13-14 years). The aim of this research is to determine the extent to which truancy relates to increased risk of road related injuries for early adolescents. Four hundred and twenty-seven Year 9 students (13-14 years) from five high schools in Queensland, Australia, completed a questionnaire about their perceptions of risk and recent injury experience. Self-reported injuries were assessed by the Extended Adolescent Injury Checklist (E-AIC). Injuries resulting from motorcycle use, bicycle use, vehicle use (as passenger or driver), and as a pedestrian were measured for the preceding three months. Students were also asked to indicate whether they sought medical attention for their injuries. Truancy rates were assessed from self-reported skipping class or wagging school over the same three month period. The findings explore the relationship between early adolescent truancy and road related injuries. The relationship between road related injuries and truancy was analysed separately for males and females. Results of this study revealed that road related injuries and reports of associated medical treatment are higher for young people who engage in truancy when compared with non-truant adolescents. The results of this study contribute knowledge about truancy as a risk factor for engagement in road related risks. The findings have the potential to enhance school policies and injury prevention programs if emphasis is placed on increasing school attendance as a safety measure to decrease road related injuries for young adolescents.

Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals

Background/objectives This study estimates the economic outcomes of a nutrition intervention to at-risk patients compared with standard care in the prevention of pressure ulcer. Subjects/methods Statistical models were developed to predict ‘cases of pressure ulcer avoided’, ‘number of bed days gained’ and ‘change to economic costs’ in public hospitals in 2002–2003 in Queensland, Australia. Input parameters were specified and appropriate probability distributions fitted for: number of discharges per annum; incidence rate for pressure ulcer; independent effect of pressure ulcer on length of stay; cost of a bed day; change in risk in developing a pressure ulcer associated with nutrition support; annual cost of the provision of a nutrition support intervention for at-risk patients. A total of 1000 random re-samples were made and the results expressed as output probability distributions. Results The model predicts a mean 2896 (s.d. 632) cases of pressure ulcer avoided; 12 397 (s.d. 4491) bed days released and corresponding mean economic cost saving of euros 2 869 526 (s.d. 2 078 715) with a nutrition support intervention, compared with standard care. Conclusion Nutrition intervention is predicted to be a cost-effective approach in the prevention of pressure ulcer in at-risk patients.

A psychosocial model of young adult passengers’ intervening in unsafe driving of their friends

Young adults are over-represented in motor vehicle crashes and the carrying of same passengers puts them at greater risk of crashing. The current study examined characteristics of the passengers who might play a positive role in reducing friends’ crashes by actively engaging in strategies to protect such friends. A psychosocial theoretical model of prosocial behavior including self-process and contextual cues explained intervening behavior among primarily novice driver college students (n=242) with the exception of the self-process, perspective taking. The results of this study provide support for countermeasure development that accounts for the positive role of peers to increase road safety, and reduce the incidence of crashes, among young adults.