Dose-related effects of flavanol-rich cocoa on blood pressure

Consumption of flavanol-containing cocoa products has been shown to lower blood pressure (BP), but the minimum dose required to reduce BP is not known. This study aimed to examine the effect of three different doses of cocoa flavanols (CF) on 24-h mean arterial BP. Twenty four hour ambulatory BP (24-ABP) monitoring was performed in 32 men and 20 postmenopausal women with untreated mild hypertension (seated clinic BP >130/85 and <160/100 mm Hg). Participants were randomized and instructed to consume daily a reconstituted cocoa beverage containing 33, 372, 712 or 1052 mg day(-1) of CF for 6 weeks in a double-blind, parallel comparison. Seated clinic BP and 24-h ABP were measured at 0, 3 and 6 weeks. Seated clinic BP did not change during the study period. There were significant reductions in 24-h systolic (5.3+/-5.1 mm Hg; P=0.001), diastolic (3+/-3.2 mm Hg; P=0.002) and mean arterial BP (3.8+/-3.2 mm Hg; P=0.0004) at the 1052 mg day(-1) CF only. No reduction in BP was seen at any other dose. No evidence of dose-response was seen in this experiment. The highest dose of 1052 mg CF per day was found to significantly lower BP. These results support previous evidence for CF to lower BP, however more research is needed to establish the most effective dose and food matrix

Primary health care delivery models in rural and remote Australia – a systematic review

© 2008 Wakerman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background One third of all Australians live outside of its major cities. Access to health services and health outcomes are generally poorer in rural and remote areas relative to metropolitan areas. In order to improve access to services, many new programs and models of service delivery have been trialled since the first National Rural Health Strategy in 1994. Inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programs. This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993–2006). The study aimed to describe what health service models were reported to work, where they worked and why. Methods A reference group of experts in rural health assisted in the development and implementation of the study. Peer-reviewed publications were identified from the relevant electronic databases. 'Grey' literature was identified pragmatically from works known to the researchers, reference lists and from relevant websites. Data were extracted and synthesised from papers meeting inclusion criteria. Results A total of 5391 abstracts were reviewed. Data were extracted finally from 76 'rural' and 17 'remote' papers. Synthesis of extracted data resulted in a typology of models with five broad groupings: discrete services, integrated services, comprehensive PHC, outreach models and virtual outreach models. Different model types assume prominence with increasing remoteness and decreasing population density. Whilst different models suit different locations, a number of 'environmental enablers' and 'essential service requirements' are common across all model types. Conclusion Synthesised data suggest that, moving away from Australian coastal population centres, sustainable models are able to address diseconomies of scale which result from large distances and small dispersed populations. Based on the service requirements and enablers derived from analysis of reported successful PHC service models, we have developed a conceptual framework that is particularly useful in underpinning the development of sustainable PHC models in rural and remote communities

Os museus históricos e pedagógicos do estado de São Paulo

This paper analyzes the creation of the Historical and Pedagogical Museums network in the State of São Paulo between 1956 and 1973, mainly taking into consideration the concept for creation, the program, and the role of the museum in society. This work covers a period until the end of the 1990's, when the curators of the museums, which belonged to the State until that time, was transferred to the municipalities by means of a "municipalization" process coordinated by the Department of Museums and Archives of the State Department of Cultural Affairs (DEMA-SEC). It also shows that the implementation of this museums network - among other initiatives in the fields of education and of culture - addressed earlier needs of asserting an identity, emphasizing through projects of this type the hegemonic character of the State. This allowed to align the initiative of creating the museums with others actions carried out by the State before, and also enabled that this topic was take out from its long isolation from the study of State history. It also considers the web of relationships existing among the various sectors with which museums were connected, such as education, culture, and the São Paulo Historical and Geographical Institute, the Government, and Society. The implementation of Historical and Pedagogical Museums by means of State action, through its Departments of Education (from 1956 to 1968) and Cultural Affairs (from 1968 to 1998) was one of the ways through which the Government orientated its activities during those years in the fields of history, education and culture. The central thesis is that the implementation of these museums has fully addressed the aspirations of society at the time, while, at the same time, underscoring the logic behind the ideation that has oriented the characteristic mode of operation of museums during the years in which their curatorship was exercised by the Government, and proposes to consider them as a paradigm for "historical museums of the State of São Paulo".Este estudo analisa a criação da rede de museus históricos e pedagógicos do estado de São Paulo entre os anos de 1956 e 1973, sobretudo quanto ao conceito de criação, de programa e de função de museu na sociedade. Tal análise estende-se ao final da década de 1990, quando a tutela dos museus, até então estadual, é transferida às cidades por meio do processo de municipalização, coordenado pelo Departamento de Museus e Arquivos, da Secretaria de Estado da Cultura (Dema-SEC). Em meio a outras iniciativas nos campos da educação e da cultura, aborda a correspondência existente entre a implantação da rede desses museus e antigas necessidades de afirmação identitária, ao evidenciar, por meio de projetos desta natureza, o caráter hegemônico do Estado e sua atuação em campos como o da história, o da educação e o da cultura. Isso permitiu alinhar a iniciativa de criação dos museus a outras anteriormente promovidas pelo estado de São Paulo e possibilitar que o tema escapasse de um prolongado isolamento no estudo da história paulista. Trata, também, da trama de relações existentes entre diversos setores ligados aos museus - educação, cultura, Instituto Histórico e Geográfico de São Paulo (IHGSP), poder público e sociedade. A hipótese central é de que a implantação desses museus correspondeu plenamente às aspirações da sociedade de uma época, ao mesmo tempo em que evidencia a lógica da ideação que determinou o modo característico de atuação dos museus nos anos em que estiveram sob a tutela do governo estadual, propondo, assim, entendê-los como paradigma de "museu histórico do estado de São Paulo"

A search for new physics in central exclusive production using the missing mass technique with the CMS detector and the CMS-TOTEM precision proton spectrometer

A generic search is presented for the associated production of a Z boson or a photon with an additional unspecified massive particle X, pp → pp + Z/γ + X, in proton-tagged events from proton–proton collisions at √s = 13 TeV, recorded in 2017 with the CMS detector and the CMS-TOTEM precision proton spectrometer. The missing mass spectrum is analysed in the 600–1600 GeV range and a fit is performed to search for possible deviations from the background expectation. No significant excess in data with respect to the background predictions has been observed. odelindependent upper limits on the visible production cross section of pp → pp + Z/γ + X are set

An oral health literacy intervention for Indigenous adults in a rural setting in Australia

BACKGROUND: Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy. METHODS/DESIGN: This is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrolment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism. DISCUSSION: This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.Eleanor J. Parker, Gary Misan, Alwin Chong, Helen Mills, Kaye Roberts-Thomson, Alice M. Horowitz and Lisa M Jamieso

Reducing disease burden and health inequalities arising from chronic disease among Indigenous children: an early childhood caries intervention

Background: This study seeks to determine if implementing a culturally-appropriate early childhood caries (ECC) intervention reduces dental disease burden and oral health inequalities among Indigenous children living in South Australia, Australia. Methods/Design: This paper describes the study protocol for a randomised controlled trial conducted among Indigenous children living in South Australia with an anticipated sample of 400. The ECC intervention consists of four components: (1) provision of dental care; (2) fluoride varnish application to the teeth of children; (3) motivational interviewing and (4) anticipatory guidance. Participants are randomly assigned to two intervention groups, immediate (n = 200) or delayed (n = 200). Provision of dental care (1) occurs during pregnancy in the immediate intervention group or when children are 24-months in the delayed intervention group. Interventions (2), (3) and (4) occur when children are 6-, 12- and 18-months in the immediate intervention group or 24-, 30- and 36-months in the delayed intervention group. Hence, all participants receive the ECC intervention, though it is delayed 24 months for participants who are randomised to the control-delayed arm. In both groups, self-reported data will be collected at baseline (pregnancy) and when children are 24- and 36-months; and child clinical oral health status will be determined during standardised examinations conducted at 24- and 36-months by two calibrated dental professionals. Discussion: Expected outcomes will address whether exposure to a culturally-appropriate ECC intervention is effective in reducing dental disease burden and oral health inequalities among Indigenous children living in South Australia.Jessica Merrick, Alwin Chong, Eleanor Parker, Kaye Roberts-Thomson, Gary Misan, John Spencer, John Broughton, Herenia Lawrence and Lisa Jamieso

Does chronic disease self-management have a role in preventing chronic disease in rural Australia?

Kate Warren, Tahna lee Pettman, Debra Misan and Gary Misanhttp://9thnrhc.ruralhealth.org.au/program/docs/program.ht

Small-scale rural pilot programmes in chronic illness management - what next?

Copyright © 2003 Australian Institute for Primary Care and School of Public HealthIn recent years, rural SA has been the recipient of significant funding to support a range of new primary health care initiatives. Much of this funding, additional to normal recurrent budgets in our health system, has facilitated effective change and development through demonstration and research projects across the state. The resultant work involves programs such as: ? coordinated care trials (COAG) ? more allied health services (MAHS) ? Commonwealth regional health service initiatives (CRHS) ? quality use of medicines (QUM) ? community packages for aged care services ? Indigenous chronic disease self-management pilot programs (CDSM) ? chronic disease self-management (CDSM) programs - Sharing Health Care SA ? chronic disease self-management (CDSM) programs in Indigenous communities. In addition to the resources listed above, funding was also provided by the Commonwealth to establish the South Australian Centre for Rural and Remote Health (SACRRH) and develop the University Department of Rural Health in Whyalla. While this new funding has led to substantial developmental work in chronic illness management in particular, one needs to ask whether the time might not be right now for these hitherto small-scale change initiatives to be transformed into ongoing mainstream programs, informed and guided by research outcomes to date. Is it time to move beyond tentative chronic illness programs and into mainstream reform? We have shown that there is much to be gained, both for patients and for the system, from improved coordination of primary care services and initiatives such as self-management programs for patients with chronic conditions. Better management leads to improved patient health outcomes and can reduce demand for unplanned hospital and emergency services. Many admissions to rural hospitals requiring expensive services, in terms of infrastructure and staffing, could be either prevented, or patients could be managed more effectively in the community as part of a wider primary health care program.P.W. Harvey, P.D. Mills, G. Misan and K. Warre

Who uses complementary and alternative therapies in regional South Australia?: evidence from the Whyalla Integrational Study of Health

OBJECTIVE: To assess the prevalence of complementary and alternative medicine (CAM) and service use for people with a chronic disease in rural and regional Australia, where reported prevalence of CAM use is higher. METHODS: Data were from the Whyalla Intergenerational Study of Health, a population representative cross sectional study of 1146 people recruited in 2008–2009. Self-reported chronic disease diagnosis and health service use including CAM use were collected. Complementary and other medicines were recorded at a clinic visit in a reduced sample (n = 722) and SF36 data were collected by questionnaire. RESULTS: Around 32% of respondents reported complementary medicine use and 27% CAM service use. There was no difference in the overall prevalence of CAM use among those with and without a chronic disease (OR 0.9, 95% CI 0.7–1.3). Greater age- and sex-adjusted use of complementary medicines was associated with the ability to save money (OR 1.75, 95% CI 1.17–2.63), but not with any other socioeconomic position indicator. Those who reported using prescribed medication were more likely to report using complementary medicines (OR 2.09, 95% CI 1.35–3.24). CONCLUSIONS: The prevalence of CAM use in this regional community appeared lower than reported in similar communities outside of South Australia. Mainstream medicine use was associated with complementary medicine use, increasing the risk of an adverse drug interaction. This suggests that doctors and pharmacists should be aware of the possibility that their clients may be using complementary medicines, and the need for vigilance regarding potential side effects and interactions between complementary and mainstream therapies. WHAT IS KNOWN ABOUT THIS TOPIC?: The prevalence of complementary and alternative therapy use in Australian rural and regional communities is high relative to urban communities. WHAT DOES THIS PAPER ADD?: The prevalence of complementary and alternative therapy use in a regional South Australian community is lower than reported elsewhere. In this community, mainstream medicine use was associated with an increased chance of complementary medicine use. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Doctors and pharmacists should be aware of the possibility that their clients may be using complementary medicines, and the need for vigilance regarding potential side effects and interactions between complementary and mainstream therapies.Katina D'Onise, Matthew T. Haren, Gary M.H. Misan and Robyn A. McDermot