Suggestion, hypnosis and hypnotherapy: a survey of use, knowledge and attitudes of anaesthetists

Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsClinical hypnosis is a skill of using words and gestures (frequently called suggestions) in particular ways to achieve specific outcomes. It is being increasingly recognised as a useful intervention for managing a range of symptoms, especially pain and anxiety. We surveyed all 317 South Australian Fellows and trainees registered with ANZCA to determine their use, knowledge of, and attitudes towards positive suggestion, hypnosis and hypnotherapy in their anaesthesia practice. The response rate was 218 anaesthetists (69%). The majority of respondents (63%) rated their level of knowledge on this topic as below average. Forty-eight per cent of respondents indicated that there was a role for hypnotherapy in clinical anaesthesia, particularly in areas seen as traditional targets for the modality, i.e. pain and anxiety states. Nearly half of the anaesthetists supported the use of hypnotherapy and positive suggestions within clinical anaesthesia. Those respondents who had experience of clinical hypnotherapy were more likely to support hypnosis teaching at undergraduate or postgraduate level when compared with those with no experience.http://www.aaic.net.au/Article.asp?D=200408

Screening pregnant women for chlamydia : what are the predictors of infection?

Objectives: To determine the risk factors associated with chlamydial infection in pregnancy and the sensitivity and specificity of these when used for selective screening.Methods: A prospective, cross-sectional study of pregnant women aged 16&ndash;25 years attending four major public antenatal services across Melbourne, Australia. Between October 2006 and July 2007, women were approached consecutively and asked to complete a questionnaire and to provide a first-pass urine specimen for Chlamydia trachomatis testing using PCR.Results: Of 1180 eligible women, 1087 were approached and 1044 (88%) consented to participate. Among the 987 women for whom a questionnaire and a definitive diagnostic assay were available, the prevalence of chlamydia was 3.2% (95% CI 1.8 to 5.9). In a multiple logistic regression model, more than one sexual partner in the past year (AOR 11.5; 95% CI 7.1 to 18.5) was associated with chlamydia infection. The use of any antibiotic within 3 months (AOR 0.2; 95% CI 0.1 to 0.6) was associated with a decreased risk of infection. Screening restricted to women who reported more than one sexual partner in the past year would have detected 44% of infections in women aged 16&ndash;25 years and would have required only 7% of women to be screened. The addition of those women aged 20 years and under would have required 27% of women to be screened and detection of 72% of infections.Conclusions: Selective chlamydia screening of pregnant women based on risk factors can improve the yield from screening. However, the potential harm of missed infections among excluded women would need to be considered.<br /

Improving chlamydia knowledge should lead to increased chlamydia testing among Australian general practitioners: a cross-sectional study of chlamydia testing uptake in general practice

Female general practitioners (GPs) have higher chlamydia testing rates than male GPs, yet it is unclear whether this is due to lack of knowledge among male GPs or because female GPs consult and test more female patients

Correction to: Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY

After the publication of this protocol [1], our collaborator Prima Health solutions advised us of their intent to withdraw from the study. Their primary role was to provide remotely delivered weight-loss services (via the Healthy Weight for Life program) to eligible participants in the intervention group. These services were partly provided as in-kind and partly funded through the study. We have received ethical approval from the University of Sydney to replace the Healthy Weight for Life program with the Commonwealth Scientific and Industrial Research Organisation's (CSIRO) Total Wellbeing Diet. The amended weight loss advice and support paragraph of the manuscript is outlined below. All changes to the protocol were made and approved before starting the trial and were prospectively changed on our trial registration (ACT RN12617001595303). Amended weight loss advice and support paragraph: If the patient has a BMI =27 kg/m2, the patient will be offered the option of participating in the remotelydelivered weight loss program. The Australian Commonwealth Scientific and Industrial Research Organisation's (CSIRO) "Total Wellbeing Diet" is based on an evidence-based weight management strategy that utilises a structured, nutritionally balanced eating plan designed to be incorporated into a balanced lifestyle program [2, 3]. The program is a 12- week, low glycaemic index, high protein, healthy eating program with online support and tracking tools, meal plans and educational resources on a healthy diet. It is delivered by SP Health (http://www.sphealth.com/) on behalf of the CSIRO. After completion of the 12-week program, patients may elect to continue the basic program for an additional 12-weeks. Patients who elect to undertake the online weight-loss program will continue to be supported by the PARTNER Care Support Team throughout their time on the weight-loss program. This program will be undertaken in conjunction with the PARTNER exercise program and educational resources on healthy lifestyle change.

Efficacy of Oral Metronidazole with Vaginal Clindamycin or Vaginal Probiotic for Bacterial Vaginosis: Randomised Placebo-Controlled Double-Blind Trial

BACKGROUND: To determine if oral metronidazole (MTZ-400 mg bid) with 2% vaginal clindamycin-cream (Clind) or a Lactobacillus acidophilus vaginal-probiotic containing oestriol (Prob) reduces 6-month bacterial vaginosis (BV) recurrence. METHODS: Double-blind placebo-controlled parallel-group single-site study with balanced randomization (1:1:1) conducted at Melbourne Sexual Health Centre, Australia. Participants with symptomatic BV [Nugent Score (NS) = 7-10 or ≥3 Amsel's criteria and NS = 4-10], were randomly allocated to MTZ-Clind, MTZ-Prob or MTZ-Placebo and assessed at 1,2,3 and 6 months. MTZ and Clind were administered for 7 days and Prob and Placebo for 12 days. Primary outcome was BV recurrence (NS of 7-10) on self-collected vaginal-swabs over 6-months. Cumulative BV recurrence rates were compared between groups by Chi-squared statistics. Kaplan-Meier, log rank and Cox regression analyses were used to compare time until and risk of BV recurrence between groups. RESULTS: 450 18-50 year old females were randomized and 408 (91%), equally distributed between groups, provided ≥1 NS post-randomization and were included in analyses; 42 (9%) participants with no post-randomization data were excluded. Six-month retention rates were 78% (n = 351). One-month BV recurrence (NS 7-10) rates were 3.6% (5/140), 6.8% (9/133) and 9.6% (13/135) in the MTZ-Clind, MTZ-Prob and MTZ-Placebo groups respectively, p = 0.13. Hazard ratios (HR) for BV recurrence at one-month, adjusted for adherence to vaginal therapy, were 0.43 (95%CI 0.15-1.22) and 0.75 (95% CI 0.32-1.76) in the MTZ-Clind and MTZ-Prob groups compared to MTZ-Plac respectively. Cumulative 6-month BV recurrence was 28.2%; (95%CI 24.0-32.7%) with no difference between groups, p = 0.82; HRs for 6-month BV recurrence for MTZ-Clind and MTZ-Prob compared to MTZ-Plac, adjusted for adherence to vaginal therapy were 1.09(95% CI = 0.70-1.70) and 1.03(95% CI = 0.65-1.63), respectively. No serious adverse events occurred. CONCLUSION: Combining the recommended first line therapies of oral metronidazole and vaginal clindamycin, or oral metronidazole with an extended-course of a commercially available vaginal-L.acidophilus probiotic, does not reduce BV recurrence. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000350426

The Wicked Machinery of Government: Malta and the Problems of Continuity under the New Model Administration

This is a study focused on the early years of British rule in Malta (1800-1813). It explores the application to the island of the “new model” of colonial government, one based on direct rule from London mediated by the continuation of existing laws and institutions. Systemic deficiencies are identified. These tended to undermine the effectiveness of direct British rule. This study also reveals, in the context of legal and constitutional continuity, unresolved tensions between modernity and tradition. The political stability of the island was damaged and the possibility of continued British possession was threatened

Correction to: Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY

After the publication of this protocol [1], our collaborator Prima Health solutions advised us of their intent to withdraw from the study. Their primary role was to provide remotely delivered weight-loss services (via the Healthy Weight for Life program) to eligible participants in the intervention group. These services were partly provided as in-kind and partly funded through the study. We have received ethical approval from the University of Sydney to replace the Healthy Weight for Life program with the Commonwealth Scientific and Industrial Research Organisation's (CSIRO) Total Wellbeing Diet. The amended weight loss advice and support paragraph of the manuscript is outlined below. All changes to the protocol were made and approved before starting the trial and were prospectively changed on our trial registration (ACT RN12617001595303). Amended weight loss advice and support paragraph: If the patient has a BMI =27 kg/m2, the patient will be offered the option of participating in the remotelydelivered weight loss program. The Australian Commonwealth Scientific and Industrial Research Organisation's (CSIRO) "Total Wellbeing Diet" is based on an evidence-based weight management strategy that utilises a structured, nutritionally balanced eating plan designed to be incorporated into a balanced lifestyle program [2, 3]. The program is a 12- week, low glycaemic index, high protein, healthy eating program with online support and tracking tools, meal plans and educational resources on a healthy diet. It is delivered by SP Health (http://www.sphealth.com/) on behalf of the CSIRO. After completion of the 12-week program, patients may elect to continue the basic program for an additional 12-weeks. Patients who elect to undertake the online weight-loss program will continue to be supported by the PARTNER Care Support Team throughout their time on the weight-loss program. This program will be undertaken in conjunction with the PARTNER exercise program and educational resources on healthy lifestyle change.

Using individual-based bioenergetic models to predict the aggregate effects of disturbance on populations : a case study with beaked whales and Navy sonar

Funding: This research was supported by the Office of Naval Research (https://www.onr.navy.mil/) grant N0001419WX00431 and N000142012045: “Integrating information on displacement caused by mid-frequency active sonar and measurements of prey field into a population consequences of disturbance model for beaked whales” awarded to Dave Moretti, ND, SW, JH, LT, KB-B, AdR & VH. Funding support for tagging was provided by the US Navy's Office of Naval Research and Living Marine Resources program, the Chief of Naval Operations' Energy and Environmental Readiness Division and the NOAA Fisheries Ocean Acoustics Program.Anthropogenic activities can lead to changes in animal behavior. Predicting population consequences of these behavioral changes requires integrating short-term individual responses into models that forecast population dynamics across multiple generations. This is especially challenging for long-lived animals, because of the different time scales involved. Beaked whales are a group of deep-diving odontocete whales that respond behaviorally when exposed to military mid-frequency active sonar (MFAS), but the effect of these nonlethal responses on beaked whale populations is unknown. Population consequences of aggregate exposure to MFAS was assessed for two beaked whale populations that are regularly present on U.S. Navy training ranges where MFAS is frequently used. Our approach integrates a wide range of data sources, including telemetry data, information on spatial variation in habitat quality, passive acoustic data on the temporal pattern of sonar use and its relationship to beaked whale foraging activity, into an individual-based model with a dynamic bioenergetic module that governs individual life history. The predicted effect of disturbance from MFAS on population abundance ranged between population extinction to a slight increase in population abundance. These effects were driven by the interaction between the temporal pattern of MFAS use, baseline movement patterns, the spatial distribution of prey, the nature of beaked whale behavioral response to MFAS and the top-down impact of whale foraging on prey abundance. Based on these findings, we provide recommendations for monitoring of marine mammal populations and highlight key uncertainties to help guide future directions for assessing population impacts of nonlethal disturbance for these and other long-lived animals.Publisher PDFPeer reviewe

Prevalent and incident bacterial vaginosis are associated with sexual and contraceptive behaviours in young Australian women

BACKGROUND To determine prevalence and incidence of bacterial vaginosis (BV) and risk factors in young sexually-active Australian women. METHODS 1093 women aged 16-25 years were recruited from primary-care clinics. Participants completed 3-monthly questionnaires and self-collected vaginal smears 6-monthly for 12-months. The primary endpoint was a Nugent Score = 7-10 (BV) and the secondary endpoint was a NS = 4-10 (abnormal flora [AF]). BV and AF prevalence estimates and 95% confidence intervals (95%CI) were derived, and adjusted odds ratios (AOR) calculated to explore epidemiological associations with prevalent BV and AF. Proportional-hazards regression models were used to examine factors associated with incident BV and AF. RESULTS At baseline 129 women had BV [11.8% (95%CI: 9.4-14.2)] and 188 AF (17.2%; 15.1-19.5). Prevalent BV was associated with having a recent female partner [AOR = 2.1; 1.0-4.4] and lack of tertiary-education [AOR = 1.9; 1.2-3.0]; use of an oestrogen-containing contraceptive (OCC) was associated with reduced risk [AOR = 0.6; 0.4-0.9]. Prevalent AF was associated with the same factors, and additionally with >5 male partners (MSP) in 12-months [AOR = 1.8; 1.2-2.5)], and detection of C.trachomatis or M.genitalium [AOR = 2.1; 1.0-4.5]. There were 82 cases of incident BV (9.4%;7.7-11.7/100 person-years) and 129 with incident AF (14.8%; 12.5-17.6/100 person-years). Incident BV and AF were associated with a new MSP [adjusted rate ratio (ARR) = 1.5; 1.1-2.2 and ARR = 1.5; 1.1-2.0], respectively. OCC-use was associated with reduced risk of incident AF [ARR = 0.7; 0.5-1.0]. CONCLUSION This paper presents BV and AF prevalence and incidence estimates from a large prospective cohort of young Australian women predominantly recruited from primary-care clinics. These data support the concept that sexual activity is strongly associated with the development of BV and AF and that use of an OCC is associated with reduced risk.This work was supported by the Commonwealth of Australia, as part of a National Chlamydia Pilot Program and the Australian National Health and Research Council (research grant number 509144). CSB, and JSH were supported by research fellowships issued by the Australian National Health and Medical Research Council (fellowship numbers 456164 and 566576 respectively). MP was supported by a Primary Health Care Research Evaluation and Development MidCareer Fellowship, Department of Health and Aging